RULE-7386

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	CLT00002
Data Element Name	CLAIM-LINE-RECORD-LT.XIX-MBESCBES-CATEGORY-OF-SERVICE
Validation Logic	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM equals '4' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
Rule Definition	If a claim is a non-denied, non-void Medicaid or Medicaid expansion CHIP service tracking claim line from an LT file and the service tracking payment amount is a non-null value and cms 64 category for federal reimbursement is equal to '01', then the claim line must have a value populated for XIX MBESCBES category of service.
Denominator Logic	# of LT claim lines with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654','686' and with CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4' and with CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1' and with CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and with CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and with CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'

Published Date	Data Guide Version	Validation Rule	Action	Field	Before	After
09/11/2020	2.4.0	RULE-7386	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
11/13/2020	2.4.0	Rule-7386	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
01/27/2021	3.0.0	RULE-7386	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
12/04/2020	2.4.0	RULE-7386	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
04/30/2021	3.0.0	RULE-7386	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4'and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4'and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
07/02/2021	3.0.0	RULE-7386	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE