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TMSIS Dataguide Medicaid.gov
Version 3.38.0

RULE-806

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 CIP00002
Data Element Name CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the TYPE-OF-SERVICE field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
Rule Definition If the type of service is populated on a non-denied claim line from an IP file, then the type of service value reported must be in the list of valid values for type of service.
Denominator Logic # of IP claim lines with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS not in '26', '87', '542', '585', '654' with CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE equal to a valid, non-null value