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TMSIS Dataguide Medicaid.gov
Version 3.38.0

RULE-7877

Validation Rule
Last updated

Tier 1.1
Tier Description Value Error
Error Category E1103
Error Category Message Value not in specified valid value set
Rule Type Valid Value
File Segment Number CLT00002
Data Element Name CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND
Validation Logic 'if CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then If the ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
Rule Definition If the type of claim is a supplemental and adjustment indicator is populated on a claim header from an LT file, then the adjustment indicator value reported must be in the list of valid values for adjustment indicator.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and with CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND equal to a non-null value