RULE-7522

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.

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.TOT-MEDICAID-PAID-AMT
Validation Logic	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', '5', '6' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT does not equal '0.00''
Rule Definition	If the non-denied claim is an IP file, and is an original, adjustment, gross adjustment or debit adjustment Medicaid/Medicaid-expansion CHIP or Separate CHIP supplemental claim, then the claim has a non-null value and not 0.00 value for total medicaid paid amount.
Denominator Logic	# of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and with CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', '5', '6' and with CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E'

Published Date	Data Guide Version	Validation Rule	Action	Field	Before	After
04/30/2021	3.0.0	RULE-7522	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is not equal to 0.00
03/11/2022	3.0.0	RULE-7522	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT does not equal '0.00''	‘if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal ‘F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal ‘0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', '5’, ’6’ and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT does not equal '0.00''