An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide Medicaid.gov
Version 3.38.0

RULE-7167

Validation Rule
Last updated

Tier 2.0
Tier Description Relational error
Error Category E2001
Error Category Message Values inconsistently specified (single record type, single record)
Rule Type One Record Type (Single Record)
File Segment Number CIP00002
Data Element Name CLAIM-HEADER-RECORD-IP.DIAGNOSIS-RELATED-GROUP • CLAIM-HEADER-RECORD-IP.DIAGNOSIS-RELATED-GROUP-IND
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then when CLAIM-HEADER-RECORD-IP.DIAGNOSIS-RELATED-GROUP-IND is a CMS DRG Grouper, as specified by prefix 'HG', CLAIM-HEADER-RECORD-IP.DIAGNOSIS-RELATED-GROUP must be a valid value. We support valid values in 'MS-DRG-VERSION-3', 'MS-DRG-VERSION-4', 'MS-DRG-VERSION-5', 'MS-DRG-VERSION-6', 'MS-DRG-VERSION-7', 'MS-DRG-VERSION-8', 'MS-DRG-VERSION-9', 'MS-DRG-VERSION-10', 'MS-DRG-VERSION-11', 'MS-DRG-VERSION-12', 'MS-DRG-VERSION-13', 'MS-DRG-VERSION-14', 'MS-DRG-VERSION-15', 'MS-DRG-VERSION-16', 'MS-DRG-VERSION-17', 'MS-DRG-VERSION-18', 'MS-DRG-VERSION-19', 'MS-DRG-VERSION-20', 'MS-DRG-VERSION-21', 'MS-DRG-VERSION-22', 'MS-DRG-VERSION-23', 'MS-DRG-VERSION-24', 'MS-DRG-VERSION-25', 'MS-DRG-VERSION-26', 'MS-DRG-VERSION-27', 'MS-DRG-VERSION-28', 'MS-DRG-VERSION-29', 'MS-DRG-VERSION-30', 'MS-DRG-VERSION-31', 'MS-DRG-VERSION-32', 'MS-DRG-VERSION-33', 'MS-DRG-VERSION-34', 'MS-DRG-VERSION-35', 'MS-DRG-VERSION-36', or 'MS-DRG-VERSION-37'.'
Rule Definition If the first two characters of the diagnosis related group indicator is 'HG' which indicates a CMS DRG Group code was assigned, then the value for the diagnosis related group must be from the following list of valid values: 'MS-DRG-VERSION-3', 'MS-DRG-VERSION-4', 'MS-DRG-VERSION-5', 'MS-DRG-VERSION-6', 'MS-DRG-VERSION-7', 'MS-DRG-VERSION-8', 'MS-DRG-VERSION-9', 'MS-DRG-VERSION-10', 'MS-DRG-VERSION-11', 'MS-DRG-VERSION-12', 'MS-DRG-VERSION-13', 'MS-DRG-VERSION-14', 'MS-DRG-VERSION-15', 'MS-DRG-VERSION-16', 'MS-DRG-VERSION-17', 'MS-DRG-VERSION-18', 'MS-DRG-VERSION-19', 'MS-DRG-VERSION-20', 'MS-DRG-VERSION-21', 'MS-DRG-VERSION-22', 'MS-DRG-VERSION-23', 'MS-DRG-VERSION-24', or 'MS-DRG-VERSION-25'
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-IP.DIAGNOSIS-RELATED-GROUP-IND beginning with 'HG'