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TMSIS Dataguide Medicaid.gov
Version 3.38.0

RULE-7293

Validation Rule
Last updated

Tier 2.1
Tier Description Relational error
Error Category E2102
Error Category Message Values inconsistently specified (multi record, single file)
Rule Type Two Record Type (1 to 1)
File Segment Number COT00002
Data Element Name CLAIM-LINE-RECORD-OT.PROCEDURE-CODE
Validation Logic 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE-FLAG, then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE'
Rule Definition #N/A
Denominator Logic # of OT claim lines with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR not equal to '0' AND with CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to 'Z' AND with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS not in ('26','026','87','087','542','585', '654') AND with CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS not in ('26','026','87','087','542','585', '654') AND with CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG equal to a valid, non-null value