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TMSIS Dataguide Medicaid.gov
Version 3.38.0

RULE-984

Validation Rule
Last updated

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 CLT00002
Data Element Name CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.MEDICARE-COMB-DED-IND equals '1', then CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT equals '0.00''
Rule Definition If a claim is a non-denied claim from an LT file, and the medicare combined deductible indicator is equal to '1', then the total medicare coinsurance amount must be 0 or null.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.MEDICARE-COMB-DED-IND equals '1'