Data Guide

Published Date	Data Guide Version	Document	Action	Field	Before	After
02/27/2025	3.34.0	ELG.002.023	UPDATE	Coding requirement	1. Value must be in Sex List (VVL)2. Value must be 1 character3. (Pregnancy) if value equals "M", then associated Pregnancy Indicator (ELG.003.049) value must not equal "1"4. Mandatory	1. Value must be in Sex List (VVL)2. Value must be 1 character4. Mandatory
02/26/2025	3.34.0	RULE-7899	UPDATE	Ta max	0.05	0.02
02/26/2025	3.34.0	EL-15-002-2	UPDATE	Specification	STEP 1: Performance indicator CHIP countRetrieve the PI CHIP enrollment count from the PI data. This is an external source. More information is available at: https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/sdis/index.htmlNote: The PI CHIP enrollment count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the PI data are ready to do the calculation, so that the PI count and T-MSIS count are for the same month.STEP 2: CHIP enrollee countUse the measure statistic from EL-S-003-3STEP 3: DifferenceSubtract the count of PI CHIP enrollment from STEP 1 from the count of CHIP enrollees from STEP 2STEP 4: PercentageDivide the difference from STEP 3 by the PI CHIP count from STEP 1	STEP 1: Performance indicator CHIP countRetrieve the PI CHIP enrollment count from the PI data. This is an external source. More information is available at: https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-data/monthly-medicaid-chip-application-eligibility-determination-and-enrollment-reports-data/index.htmlNote: The PI CHIP enrollment count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the PI data are ready to do the calculation, so that the PI count and T-MSIS count are for the same month.STEP 2: CHIP enrollee countUse the measure statistic from EL-S-003-3STEP 3: DifferenceSubtract the count of PI CHIP enrollment from STEP 1 from the count of CHIP enrollees from STEP 2STEP 4: PercentageDivide the difference from STEP 3 by the PI CHIP count from STEP 1
02/26/2025	3.34.0	EL-15-001-1	UPDATE	Specification	STEP 1: Performance indicator enrollment count Retrieve the total PI enrollment count (Medicaid + CHIP) from the PI data. This is an external source. More information is available at: https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/sdis/index.html Note: The PI enrollment count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the PI data are ready to do the calculation, so that the PI count and T-MSIS count are for the same month.STEP 2: Full-benefit enrollee countUse the measure statistic from EL-6-023-23STEP 3: Difference Subtract the count of total PI enrollment from STEP 1 from the count of full-benefit enrollees from STEP 2STEP 4: PercentageDivide the difference from STEP 3 by the count in STEP 1	STEP 1: Performance indicator enrollment count Retrieve the total PI enrollment count (Medicaid + CHIP) from the PI data. This is an external source. More information is available at: https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-data/monthly-medicaid-chip-application-eligibility-determination-and-enrollment-reports-data/index.htmlNote: The PI enrollment count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the PI data are ready to do the calculation, so that the PI count and T-MSIS count are for the same month.STEP 2: Full-benefit enrollee countUse the measure statistic from EL-6-023-23STEP 3: Difference Subtract the count of total PI enrollment from STEP 1 from the count of full-benefit enrollees from STEP 2STEP 4: PercentageDivide the difference from STEP 3 by the count in STEP 1
02/26/2025	3.34.0	Data Quality Measures	UPDATE	Version text	3.13	3.13.1
12/18/2024	3.33.0	Data Quality Measures	UPDATE	Version text	3.13.0	3.13
02/27/2025	3.34.0	CRX.002.162	UPDATE	Coding requirement	1. Value must be one digit2. Value must be 1:43. Conditional	1. Value must be one digit2. Value must be in Prescription Origin Code List (VVL)3. Conditional
12/10/2024	3.33.0	CRX.002.162	UPDATE	Medicaid valid value info	See https://www.ncpdp.org/	For background and context, see https://www.ncpdp.org/
12/18/2024	3.33.0	RULE-7785	UPDATE	Adjustment type	Original	Non-void
10/07/2024	3.30.0	RULE-7785	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7784	UPDATE	Adjustment type	Original	Non-void
10/07/2024	3.30.0	RULE-7784	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7783	UPDATE	Adjustment type	Original	Non-void
10/07/2024	3.30.0	RULE-7783	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7782	UPDATE	Adjustment type	Original	Non-void
10/07/2024	3.30.0	RULE-7782	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7936	UPDATE	Adjustment type	Original	Original and Replacement
10/07/2024	3.30.0	RULE-7936	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7935	UPDATE	Measure name	% of claim headers with a Servicing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Ending Date of Service	% of claim lines with a Servicing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Ending Date of Service
12/18/2024	3.33.0	RULE-7935	UPDATE	Adjustment type	Original	Original and Replacement
10/07/2024	3.30.0	RULE-7935	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7934	UPDATE	Measure name	% of claim headers with a Servicing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Ending Date of Service	% of claim lines with a Servicing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Ending Date of Service
12/18/2024	3.33.0	RULE-7934	UPDATE	Adjustment type	Original	Original and Replacement
10/07/2024	3.30.0	RULE-7934	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7933	UPDATE	Measure name	% of claim headers with a Servicing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Ending Date of Service	% of claim lines with a Servicing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Ending Date of Service
12/18/2024	3.33.0	RULE-7933	UPDATE	Adjustment type	Original	Original and Replacement
10/07/2024	3.30.0	RULE-7933	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7928	UPDATE	Adjustment type	Original	Original and Replacement
12/18/2024	3.33.0	RULE-7928	UPDATE	Focus area	N/A	Managed care
10/07/2024	3.30.0	RULE-7928	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7927	UPDATE	Measure name	% of claim headers with a Servicing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Ending Date of Service	% of claim lines with a Servicing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Ending Date of Service
12/18/2024	3.33.0	RULE-7927	UPDATE	Adjustment type	Original	Original and Replacement
12/18/2024	3.33.0	RULE-7927	UPDATE	Focus area	N/A	Managed care
10/07/2024	3.30.0	RULE-7927	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7926	UPDATE	Measure name	% of claim headers with a Servicing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Ending Date of Service	% of claim lines with a Servicing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Ending Date of Service
12/18/2024	3.33.0	RULE-7926	UPDATE	Adjustment type	Original	Original and Replacement
12/18/2024	3.33.0	RULE-7926	UPDATE	Focus area	N/A	Managed care
10/07/2024	3.30.0	RULE-7926	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7925	UPDATE	Measure name	% of claim headers with a Servicing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Ending Date of Service	% of claim lines with a Servicing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Ending Date of Service
12/18/2024	3.33.0	RULE-7925	UPDATE	Adjustment type	Original	Original and Replacement
12/18/2024	3.33.0	RULE-7925	UPDATE	Focus area	N/A	Managed care
10/07/2024	3.30.0	RULE-7925	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7932	UPDATE	Adjustment type	Original	Original and Replacement
10/07/2024	3.30.0	RULE-7932	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7931	UPDATE	Adjustment type	Original	Original and Replacement
10/07/2024	3.30.0	RULE-7931	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7930	UPDATE	Adjustment type	Original	Original and Replacement
10/07/2024	3.30.0	RULE-7930	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7929	UPDATE	Adjustment type	Original	Original and Replacement
10/07/2024	3.30.0	RULE-7929	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7924	UPDATE	Adjustment type	Original	Original and Replacement
12/18/2024	3.33.0	RULE-7924	UPDATE	Focus area	N/A	Managed care
10/07/2024	3.30.0	RULE-7924	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7923	UPDATE	Adjustment type	Original	Original and Replacement
12/18/2024	3.33.0	RULE-7923	UPDATE	Focus area	N/A	Managed care
10/07/2024	3.30.0	RULE-7923	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7922	UPDATE	Adjustment type	Original	Original and Replacement
12/18/2024	3.33.0	RULE-7922	UPDATE	Focus area	N/A	Managed care
10/07/2024	3.30.0	RULE-7922	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7921	UPDATE	Adjustment type	Original	Original and Replacement
12/18/2024	3.33.0	RULE-7921	UPDATE	Focus area	N/A	Managed care
10/07/2024	3.30.0	RULE-7921	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7975	UPDATE	Claim type	Medicaid,Enc or CHIP,Enc	Medicaid,FFS or CHIP,FFS
10/07/2024	3.30.0	RULE-7975	ADD	N/A		Created
10/07/2024	3.30.0	RULE-7974	ADD	N/A		Created
10/07/2024	3.30.0	RULE-7979	ADD	N/A		Created
10/07/2024	3.30.0	RULE-7978	ADD	N/A		Created
10/07/2024	3.30.0	RULE-7977	ADD	N/A		Created
10/07/2024	3.30.0	RULE-7976	ADD	N/A		Created
10/07/2024	3.30.0	RULE-7636	ADD	N/A		Created
10/07/2024	3.30.0	RULE-7635	ADD	N/A		Created
10/07/2024	3.30.0	RULE-7634	ADD	N/A		Created
10/07/2024	3.30.0	RULE-7633	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7900	UPDATE	Adjustment type	All Adjustment Types	Non-void
10/07/2024	3.30.0	RULE-7900	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7899	UPDATE	Adjustment type	All Adjustment Types	Non-void
10/07/2024	3.30.0	RULE-7899	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7898	UPDATE	Adjustment type	All Adjustment Types	Non-void
10/07/2024	3.30.0	RULE-7898	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7897	UPDATE	Adjustment type	All Adjustment Types	Non-void
10/07/2024	3.30.0	RULE-7897	ADD	N/A		Created
12/18/2024	3.33.0	Data Quality Measures	UPDATE	Version text	3.12.1	3.13.0
02/27/2025	3.34.0	ELG.005.097	UPDATE	Coding requirement	1. Value must be in Restricted Benefits Code List (VVL)2. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "05", then Eligibility Group (ELG.005.087) must be "24"3. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "06", then Eligibility Group (ELG.005.087) must be "26"4. (Restricted Benefits) if value is "1" and Dual Eligible Code (ELG.005.085) value is "02", then Eligibility Group (ELG.005.087) must be "23"5. (Restricted Benefits) if value is "1" and Dual Eligible Code (ELG.005.085) value is "04", then Eligibility Group (ELG.005.087) must be "25"6. (Restricted Benefits) if value is "3", then Dual Eligible Code (ELG.005.085) cannot be "00"7. Mandatory8. If value is populated, then Eligibility Group (ELG.005.087) must be populated9. If value is "6" then Eligibility Group(ELG.DE.087) must be in [35,70]10. If value is "1" or "7" then Eligibility Group (EGL.DE.087) must be in [72,73,74,75] and State Plan Option Type (ELG.DE.163) must equal "06"11. (Restricted Pregnancy-Related) if value is "4", then associated Sex (ELG.002.023) value must be "F"12. (Non-Citizen) if value is "2", then associated Citizenship Indicator (ELG.003.040) value must not be equal to "1"13. If value is "D", there must be a corresponding MFP enrollment segment (ELG00010) with Effective and End dates that are within the timespan of this segment14. Value must be 1 character15. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "01", then Eligibility Group (ELG.005.087) must be "23"16. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "03", then Eligibility Group (ELG.005.087) must be "25"17. (Restricted Benefits) if value is "G", then Dual Eligible Code (ELG.005.085) must be in [01,03,06]	1. Value must be in Restricted Benefits Code List (VVL)2. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "05", then Eligibility Group (ELG.005.087) must be "24"3. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "06", then Eligibility Group (ELG.005.087) must be "26"4. (Restricted Benefits) if value is "1" and Dual Eligible Code (ELG.005.085) value is "02", then Eligibility Group (ELG.005.087) must be "23"5. (Restricted Benefits) if value is "1" and Dual Eligible Code (ELG.005.085) value is "04", then Eligibility Group (ELG.005.087) must be "25"6. (Restricted Benefits) if value is "3", then Dual Eligible Code (ELG.005.085) cannot be "00"7. Mandatory8. If value is populated, then Eligibility Group (ELG.005.087) must be populated9. If value is "6" then Eligibility Group(ELG.DE.087) must be in [35,70]10. If value is "1" or "7" then Eligibility Group (EGL.DE.087) must be in [72,73,74,75] and State Plan Option Type (ELG.DE.163) must equal "06"11. (Restricted Benefits) if value is "G", then Dual Eligible Code (ELG.005.085) must be in [01,03,06]12. (Non-Citizen) if value is "2", then associated Citizenship Indicator (ELG.003.040) value must not be equal to "1"13. If value is "D", there must be a corresponding MFP enrollment segment (ELG00010) with Effective and End dates that are within the timespan of this segment14. Value must be 1 character15. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "01", then Eligibility Group (ELG.005.087) must be "23"16. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "03", then Eligibility Group (ELG.005.087) must be "25"
02/27/2025	3.34.0	ELG.003.269	UPDATE	Definition	This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.	This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiaryâ€™s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.
02/27/2025	3.34.0	ELG.003.044	UPDATE	Definition	The date the five-year bar for an individual ends. Section 403 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) provides that certain immigrants who enter the United States on or after August 22, 1996 are not eligible to receive federally-funded benefits, including Medicaid and the State Children's Health Insurance Program (Separate CHIP), for five years from the date they enter the country with a status as a "qualified alien."	The date the five-year bar for an individual ends. Section 403 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) provides that certain immigrants who enter the United States on or after August 22, 1996 are not eligible to receive federally-funded benefits, including Medicaid and the State Children's Health Insurance Program (Separate CHIP), for five years from the date they enter the country with a status as a "qualified noncitizen."
02/27/2025	3.34.0	ELG.003.038	UPDATE	Definition	A code indicating the federal poverty level range in which the family income falls. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.	A code indicating the federal poverty level range in which the family income falls. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiaryâ€™s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.
02/27/2025	3.34.0	ELG.003.034	UPDATE	Definition	A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization). Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the state’s marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value.	A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization). Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the stateâ€™s marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value.
02/20/2025	3.34.0	ELG.002.023	UPDATE	Definition	Either individual's biological sex or their self-identified sex.	The individual's biological sex assigned at birth.
02/27/2025	3.34.0	CRX.003.150	UPDATE	Coding requirement	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is "01", then a valid value is mandatory and must be reported5. If value is in [14,35,42,44], then Sex (ELG.002.023) must not equals "M"6. If XXI MBESCBES Category of Service is populated then must not be populated	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is "01", then a valid value is mandatory and must be reported5. If XXI MBESCBES Category of Service is populated then must not be populated
09/30/2024	3.30.0	CRX.002.069	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be "01" or in [21-30](1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be "01" or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional
02/27/2025	3.34.0	CRX.002.058	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim linesâ€™ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
02/27/2025	3.34.0	CRX.002.032	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = "22" to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = "23" to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = "22" to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = "23" to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€œ23â€ to indicate that the sub-capitated network provider provided the service directly to the enrollee.
02/27/2025	3.34.0	CRX.002.029	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or â€œCâ€ for an S-CHIP sub-capitated encounter record.
02/27/2025	3.34.0	COT.003.211	UPDATE	Coding requirement	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is "01",then a valid value is mandatory and must be reported5. If value is in [14,35,42,44],then Sex (ELG.002.023) must not equals "M"6. If XXI MBESCBES Category of Service is populated then must not be populated	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is "01",then a valid value is mandatory and must be reported5. If XXI MBESCBES Category of Service is populated then must not be populated
02/27/2025	3.34.0	COT.003.186	UPDATE	Coding requirement	1. Value must be 3 characters2. Mandatory3. When value is in [119-122],Servicing Provider NPI Num (COT.002.190) should not be populated4. Value must be in [002,003,004,005,006,007,008,010,011,012,013,014,015,016,017,018,019,020,021,022,023,024,025,026,027,028,029,030,031,032,035,036,037,038,039,040,041,042,043,049,050,051,052,053,054,055,056,057,058,060,061,062,063,064,065,066,067,068,069,070,071,072,073,074,075,076,077,078,079,080,081,082,083,084,085,086,087,088,089,115,119,120,121,122,127,131,134,135,136,137,138,139,140,141,142,143,144,145,147]5. When value is in [119-122], Servicing Provider Taxonomy (COT.003.191) should not be populated6. When value is in [119-122], Referring Provider NPI Num (COT.002.118) should not be populated7. Value must be 3 characters8. When value is in [119-122], Billing Provider NPI Num (COT.002.113) should not be populated9. When value is in [119-122], Billing Provider Taxonomy (COT.002.114) should not be populated10. When value is in [119-122], Referring Provider Taxonomy (COT.002.119) should not be populated11. When value is not in [025,085], Sex (ELG.002.023) equals "M"12. When value is in [119-122], Servicing Provider Num (COT.002.189) should not be populated	1. Value must be 3 characters2. Mandatory3. When value is in [119-122],Servicing Provider NPI Num (COT.002.190) should not be populated4. Value must be in [002,003,004,005,006,007,008,010,011,012,013,014,015,016,017,018,019,020,021,022,023,024,025,026,027,028,029,030,031,032,035,036,037,038,039,040,041,042,043,049,050,051,052,053,054,055,056,057,058,060,061,062,063,064,065,066,067,068,069,070,071,072,073,074,075,076,077,078,079,080,081,082,083,084,085,086,087,088,089,115,119,120,121,122,127,131,134,135,136,137,138,139,140,141,142,143,144,145,147]5. When value is in [119-122], Servicing Provider Taxonomy (COT.003.191) should not be populated6. When value is in [119-122], Referring Provider NPI Num (COT.002.118) should not be populated7. Value must be 3 characters8. When value is in [119-122], Billing Provider NPI Num (COT.002.113) should not be populated9. When value is in [119-122], Billing Provider Taxonomy (COT.002.114) should not be populated10. When value is in [119-122], Referring Provider Taxonomy (COT.002.119) should not be populated11. When value is in [119-122], Servicing Provider Num (COT.002.189) should not be populated
09/30/2024	3.30.0	COT.002.111	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be "01" or in [21-30](1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be "01" or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Conditional
02/27/2025	3.34.0	COT.002.068	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim linesâ€™ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
02/27/2025	3.34.0	COT.002.037	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record. For sub-capitation payments, report TYPE-OF-CLAIM = "6" or “F”.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or â€œCâ€ for an S-CHIP sub-capitated encounter record. For sub-capitation payments, report TYPE-OF-CLAIM = "6" or â€œFâ€.
02/27/2025	3.34.0	CLT.003.224	UPDATE	Coding requirement	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is "01", then a valid value is mandatory and must be reported5. If value is in [14,35,42,44], then Sex (ELG.002.023) must not equal "M"6. If XXI MBESCBES Category of Service is populated, then must not be populated	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is "01", then a valid value is mandatory and must be reported5. If XXI MBESCBES Category of Service is populated, then must not be populated
09/30/2024	3.30.0	CLT.002.129	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be "01" or in [21-30](1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be "01" or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional
02/27/2025	3.34.0	CLT.002.082	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim linesâ€™ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
02/27/2025	3.34.0	CLT.002.056	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = "22" to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = "23" to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = "22" to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = "23" to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€œ23â€ to indicate that the sub-capitated network provider provided the service directly to the enrollee.
02/27/2025	3.34.0	CLT.002.052	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or â€œCâ€ for an S-CHIP sub-capitated encounter record.
02/27/2025	3.34.0	CIP.003.270	UPDATE	Coding requirement	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is "01", then a valid value is mandatory and must be reported5. If value is in [14,35,42,44], then Sex (ELG.002.023) must not equal "M"6. If XXI MBESCBES Category of Service is populated then must not be populated	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is "01", then a valid value is mandatory and must be reported5. If XXI MBESCBES Category of Service is populated then must not be populated
02/27/2025	3.34.0	CIP.003.257	UPDATE	Coding requirement	1. Value must be 3 characters2. Mandatory3. Value must not equal "086" if Sex (ELG.002.023) equals "M"4. Value must be in [001,058,060,084,086,090,091,092,093,123,132,135,136,137]	1. Value must be 3 characters2. Mandatory3. Value must be in [001,058,060,084,086,090,091,092,093,123,132,135,136,137]
09/30/2024	3.30.0	CIP.002.178	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30](1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional
02/27/2025	3.34.0	CIP.002.132	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim linesâ€™ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
02/27/2025	3.34.0	CIP.002.104	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = "22" to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = "23" to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = "22" to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = "23" to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = â€œ23â€ to indicate that the sub-capitated network provider provided the service directly to the enrollee.
02/27/2025	3.34.0	CIP.002.100	UPDATE	Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or â€œCâ€ for an S-CHIP sub-capitated encounter record.
06/19/2024	3.27.0	RULE-7421	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7420	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7419	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7912	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7908	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7824	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7759	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7827	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7763	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7911	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7907	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7919	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7914	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7823	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7758	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7910	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7906	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7918	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7913	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7822	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7757	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7820	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7762	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7909	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7905	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7917	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7916	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7821	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7756	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7818	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7760	ADD	N/A		Created
02/26/2025	3.34.0	EL-6-041-41	UPDATE	Priority	N/A	High
02/26/2025	3.34.0	EL-6-041-41	UPDATE	Category	N/A	Beneficiary eligibility
02/26/2025	3.34.0	EL-6-041-41	UPDATE	For ta comprehensive	No	TA- Inferential
02/26/2025	3.34.0	EL-6-041-41	UPDATE	For ta inferential	No	Yes
02/26/2025	3.34.0	EL-6-041-41	UPDATE	Ta min		0
02/26/2025	3.34.0	EL-6-041-41	UPDATE	Ta max		0.05
02/26/2025	3.34.0	EL-6-041-41	UPDATE	Threshold minimum	TBD	0
02/26/2025	3.34.0	EL-6-041-41	UPDATE	Threshold maximum	TBD	0.05
02/26/2025	3.34.0	EL-6-041-41	UPDATE	Annotation	N/A	Calculate the percentage of MSIS IDs enrolled in the past 12 months with at least three gaps in enrollment during that time period
02/26/2025	3.34.0	EL-6-041-41	UPDATE	Specification	N/A	STEP 1: Enrolled at any time within the past 12 monthsDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= 12 months prior to last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Enrollment Type is Medicaid or CHIPUsing the MSIS IDs that meet the criteria from STEP 1, further refine the population by keeping records with: 1. ENROLLMENT-TYPE = "1" or "2"STEP 3: Non-duplicate enrollment spansDuplicate records are dropped if the following three data elements are the same: MSIS-IDENTIFICATION-NUM, ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATESTEP 4: Sort records chronologically for each MSIS IDFor each MSIS ID identified in STEP 2, sort records chronologically by ENROLLMENT-EFF-DATE and ENROLLMENT-END-DATESTEP 5: Maximum enrollment end date thus farFor each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Max_End_Date_Thus_Far = the maximum value for ENROLLMENT-END-DATE for that combinationSTEP 6: Total record count by MSIS IDFor each MSIS ID identified in STEP 2, set Tot_Rec = Count of unique combinations of ENROLLMENT-EFF-DATE and ENROLLMENT-END-DATESTEP 7: Previous enrollment end dateFor each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Prev_Enrollment_End_Date = the ENROLLMENT-END-DATE value immediately prior to the ENROLLMENT-END-DATE value for that combinationSTEP 8: Enrollment span startFor each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Enrollment_Span_Start = "1" as follows:1a. Tot_Rec = 1 for the MSIS IDOR1b. ENROLLMENT-EFF-DATE is greater than Prev_Enrollment_End_Date ELSESet Enrollment_Span_Start = "0"STEP 9: Total count of noncontiguous enrollment spansFor each MSIS ID that meets the criteria from STEP 2, set Tot_Enrollment_Span = Count of rows where Enrollment_Span_Start = "1"STEP 10: Count of MSIS IDs with three or more enrollment gapsFor each MSIS ID that meets the criteria from STEP 2, further refine the population by keeping records where Tot_Enrollment_Span is greater than 3. Note that since gaps exist between enrollment spans, there must be at least 4 noncontiguous enrollment spans to equal 3 enrollment gaps for a given MSIS ID. STEP 11: Calculate percentage for measureDivide the count of MSIS IDs from STEP 10 by the count of MSIS IDs from STEP 2
02/26/2025	3.34.0	EL-6-041-41	UPDATE	Focus area	N/A	Enrollment monitoring
06/19/2024	3.27.0	EL-6-041-41	ADD	N/A		Created
02/26/2025	3.34.0	EL-3-034-43	UPDATE	Priority	N/A	High
02/26/2025	3.34.0	EL-3-034-43	UPDATE	Category	N/A	Beneficiary eligibility
02/26/2025	3.34.0	EL-3-034-43	UPDATE	For ta comprehensive	No	TA- Inferential
02/26/2025	3.34.0	EL-3-034-43	UPDATE	For ta inferential	No	Yes
02/26/2025	3.34.0	EL-3-034-43	UPDATE	Ta min		0
02/26/2025	3.34.0	EL-3-034-43	UPDATE	Ta max		0.3
02/26/2025	3.34.0	EL-3-034-43	UPDATE	Threshold minimum	TBD	0
02/26/2025	3.34.0	EL-3-034-43	UPDATE	Threshold maximum	TBD	0.3
02/26/2025	3.34.0	EL-3-034-43	UPDATE	Annotation	N/A	Calculate the percentage of MSIS IDs with a ELIGIBILITY-GROUP value of "05", where SEX is not "M", that are between the ages of 40 and 44
02/26/2025	3.34.0	EL-3-034-43	UPDATE	Specification	N/A	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: ELIGIBILITY-GROUP = "05"Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with ELIGIBILITY-GROUP = "05"STEP 4: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: SEX is not equal to "M"Of the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records where SEX is not "M" STEP 6: Calculate AgeOf the MSIS IDs that meet the criteria from STEP 5, calculate age:1a. If DATE-OF-DEATH is non-missing and occurs before the last day of the DQ report month, Age is equal to the years between DATE-OF-DEATH and DATE-OF-BIRTH.1b. Otherwise, Age is equal to the years between the last day of the DQ report month and DATE-OF-BIRTH.STEP 7: Individuals between the ages of 40 and 44Refine the MSIS IDs from STEP 6 by keeping records with:1. Age >= 40 and Age <= 44STEP 8: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 7 by the count of MSIS IDs from STEP 3
06/19/2024	3.27.0	EL-3-034-43	ADD	N/A		Created
02/26/2025	3.34.0	EL-3-033-42	UPDATE	Priority	N/A	High
02/26/2025	3.34.0	EL-3-033-42	UPDATE	Category	N/A	Beneficiary eligibility
02/26/2025	3.34.0	EL-3-033-42	UPDATE	For ta comprehensive	No	TA- Inferential
02/26/2025	3.34.0	EL-3-033-42	UPDATE	For ta inferential	No	Yes
02/26/2025	3.34.0	EL-3-033-42	UPDATE	Ta min		0
02/26/2025	3.34.0	EL-3-033-42	UPDATE	Ta max		0.05
02/26/2025	3.34.0	EL-3-033-42	UPDATE	Threshold minimum	TBD	0
02/26/2025	3.34.0	EL-3-033-42	UPDATE	Threshold maximum	TBD	0.05
02/26/2025	3.34.0	EL-3-033-42	UPDATE	Annotation	N/A	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "11" that are not receiving full benefits
02/26/2025	3.34.0	EL-3-033-42	UPDATE	Specification	N/A	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: ELIGIBILITY-GROUP = "11"Of the MSIS IDs that meet criteria from STEP 2, futher refine the population by keeping records with ELIGIBILITY-GROUP = "11"STEP 4: Enrollees without full benefitsOf the MSIS ID's that meet the criteria from STEP 3, further refine the population by keeping records that satisfy the following criteria:1. RESTRICTED-BENEFITS-CODE is not ("1", "4", "5" "7", "A", "B", "D") OR2. RESTRICTED-BENEFITS-CODE is missingSTEP: 5: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 4 by the count of MSIS IDs from STEP 3
06/19/2024	3.27.0	EL-3-033-42	ADD	N/A		Created
12/18/2024	3.33.0	MCR-59P-004-16	UPDATE	Threshold maximum	0.3	0.01
12/18/2024	3.33.0	MCR-56P-001-1	UPDATE	Threshold maximum	0.01	0.05
12/18/2024	3.33.0	EXP-41P-001-1	UPDATE	Threshold maximum	0.05	0.1
12/18/2024	3.33.0	EXP-22P-009-9	UPDATE	Threshold maximum	0.05	0.1
12/18/2024	3.33.0	EXP-37P-001-1-2	UPDATE	Threshold maximum	0.05	0.3
12/18/2024	3.33.0	EXP-33P-001-1	UPDATE	Threshold maximum	0.05	0.1
12/18/2024	3.33.0	EXP-29P-001-1	UPDATE	Threshold maximum	0.05	0.1
10/07/2024	3.30.0	EL-3-029-38	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: RESTRICTED-BENEFITS-CODE = "4"Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with RESTRICTED-BENEFITS-CODE = "4"STEP 4: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: SEX = "M"Of the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with with SEX = "M"STEP 6: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 5 by the count of MSIS IDs from STEP 1	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: RESTRICTED-BENEFITS-CODE = "4"Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with RESTRICTED-BENEFITS-CODE = "4"STEP 4: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: SEX = "M"Of the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with with SEX = "M"STEP 6: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 5 by the count of MSIS IDs from STEP 3
10/07/2024	3.30.0	EL-3-028-37	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHICS-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Pregnancy Indicator = "1"Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with PREGNANCY-INDICATOR= "1"STEP 4: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: SEX = "M"Of the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with with SEX = "M"STEP 6: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 5 by the count of MSIS IDs from STEP 1	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHICS-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Pregnancy Indicator = "1"Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with PREGNANCY-INDICATOR= "1"STEP 4: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: SEX = "M"Of the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with with SEX = "M"STEP 6: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 5 by the count of MSIS IDs from STEP 3
10/07/2024	3.30.0	EXP-13-003_1-6	UPDATE	Annotation	Calculate the percentage of S-CHIP FFS: original, non-crossover, paid OT claims billed at the line level where the total amount billed is $0	Calculate the percentage of S-CHIP FFS: original, non-crossover, paid OT claims billed at the line level where the billed amount is $0
10/07/2024	3.30.0	EXP-13-003_1-6	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims that meet the criteria from STEP 2, count records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Billed amount $0Of the claims that meet the criteria from STEP 3, count records with1. TOT-BILLED-AMT = "0"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims that meet the criteria from STEP 2, count records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Billed amount $0Of the claims that meet the criteria from STEP 3, count records with1. BILLED-AMT = "0"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
10/07/2024	3.30.0	EL-1-009-8	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Ethnicity information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ETHNICITY-INFORMATION-ELG00015 by keeping active records that satisfy the following criteria:1a. ETHNICITY-DECLARATION-EFF-DATE <= last day of the DQ report month2a. ETHNICITY-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. ETHNICITY-DECLARATION-EFF-DATE is missing2b. ETHNICITY-DECLARATION-END-DATE is missingSTEP 3: Non-missing ethnicityOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. ETHNICITY-CODE non-missingSTEP 4: Percent ethnicity for the current month1. For each distinct value of ethnicity code, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Set the total number of unique MSIS IDs across all valid values of ethnicity code as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3. 3. For each distinct value of ethnicity code, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count. STEP 5: Percent ethnicity for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of ethnicity code, set the percent of ethnicity code for the previous month as Percent_Prior_Month_1.STEP 6: Calculate change between monthsFor each frequency percent, calculate Frequency_Change as the absolute value of (Percent_Current_Month – Percent_Prior_Month_1) / 2. Note that Frequency_Change is a vector of frequencies.STEP 7: Calculate index of dissimilarityCalculate the index of dissimilarity by summing Frequency_Change across all frequencies and dividing by 100	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Ethnicity information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ETHNICITY-INFORMATION-ELG00015 by keeping active records that satisfy the following criteria:1a. ETHNICITY-DECLARATION-EFF-DATE <= last day of the DQ report month2a. ETHNICITY-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. ETHNICITY-DECLARATION-EFF-DATE is missing2b. ETHNICITY-DECLARATION-END-DATE is missingSTEP 3: Non-missing ethnicityOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. ETHNICITY-CODE non-missingSTEP 4: Percent ethnicity for the current month1. For each distinct value of ethnicity code, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Sum the total number of unique MSIS IDs within each valid value of ethnicity and set as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3.3. For each distinct value of ethnicity code, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count. STEP 5: Percent ethnicity for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of ethnicity code, set the percent of ethnicity code for the previous month as Percent_Prior_Month_1.STEP 6: Calculate change between monthsFor each frequency percent, calculate Frequency_Change as the absolute value of (Percent_Current_Month – Percent_Prior_Month_1) / 2. Note that Frequency_Change is a vector of frequencies.STEP 7: Calculate index of dissimilarityCalculate the index of dissimilarity by summing Frequency_Change across all frequencies
10/07/2024	3.30.0	EL-1-008-7	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Non-missing raceOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. RACE is non-missingSTEP 4: Percent race for the current month1. For each distinct value of race, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Set the total number of unique MSIS IDs across all valid values of race as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3. 3. For each distinct value of race, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count. STEP 5: Percent race for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of race, set the percent of race for the previous month as Percent_Prior_Month_1.STEP 6: Calculate change between monthsFor each frequency percent, calculate Frequency_Change as the absolute value of (Percent_Current_Month – Percent_Prior_Month_1) / 2. Note that Frequency_Change is a vector of frequencies.STEP 7: Calculate index of dissimilarityCalculate the index of dissimilarity by summing Frequency_Change across all frequencies and dividing by 100	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Non-missing raceOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. RACE is non-missingSTEP 4: Percent race for the current month1. For each distinct value of race, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Sum the total number of unique MSIS IDs within each valid value of ethnicity and set as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3.3. For each distinct value of race, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count. STEP 5: Percent race for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of race, set the percent of race for the previous month as Percent_Prior_Month_1.STEP 6: Calculate change between monthsFor each frequency percent, calculate Frequency_Change as the absolute value of (Percent_Current_Month – Percent_Prior_Month_1) / 2. Note that Frequency_Change is a vector of frequencies.STEP 7: Calculate index of dissimilarityCalculate the index of dissimilarity by summing Frequency_Change across all frequencies
10/07/2024	3.30.0	EL-1-007-5	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligible contact information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBLE_CONTACT_INFORMATION ELG00004 by keeping records that satisfy the following criteria:1a. ELIGIBLE-ADDR-EFF-DATE <= last day of the DQ report month2a. ELIGIBLE-ADDR-END-DATE >= last day of the DQ report month OR missingOR1b. ELIGIBLE-ADDR-EFF-DATE is missing2b. ELIGIBLE-ADDR-END-DATE is missingSTEP 3: Non-missing zip code for primary addressOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. ELIGIBLE-ZIP-CODE non-missing2. ELIGIBLE_ADDRESS_TYPE = "01"STEP 4: Percent eligible zip code for the current month1. For each distinct value of zip code, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Set the total number of unique MSIS IDs across all valid values of zip code as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3. 3. For each distinct value of zip code, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count.STEP 5: Percent zip code for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of zip code, set the percent of zip code for the previous month as Percent_Prior_Month_1. STEP 6: Calculate change between monthsFor each frequency percent, calculate Frequency_Change as the absolute value of (Percent_Current_Month – Percent_Prior_Month_1) / 2. Note that Frequency_Change is a vector of frequencies.STEP 7: Calculate index of dissimilarityCalculate the index of dissimilarity by summing Frequency_Change across all frequencies and dividing by 100	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligible contact information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBLE_CONTACT_INFORMATION ELG00004 by keeping records that satisfy the following criteria:1a. ELIGIBLE-ADDR-EFF-DATE <= last day of the DQ report month2a. ELIGIBLE-ADDR-END-DATE >= last day of the DQ report month OR missingOR1b. ELIGIBLE-ADDR-EFF-DATE is missing2b. ELIGIBLE-ADDR-END-DATE is missingSTEP 3: Non-missing zip code for primary addressOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. ELIGIBLE-ZIP-CODE non-missing2. ELIGIBLE_ADDRESS_TYPE = "01"STEP 4: Percent eligible zip code for the current month1. For each distinct value of zip code, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Sum the total number of unique MSIS IDs within each valid value of ethnicity and set as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3.3. For each distinct value of zip code, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count.STEP 5: Percent zip code for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of zip code, set the percent of zip code for the previous month as Percent_Prior_Month_1. STEP 6: Calculate change between monthsFor each frequency percent, calculate Frequency_Change as the absolute value of (Percent_Current_Month – Percent_Prior_Month_1) / 2. Note that Frequency_Change is a vector of frequencies.STEP 7: Calculate index of dissimilarityCalculate the index of dissimilarity by summing Frequency_Change across all frequencies
10/07/2024	3.30.0	EL-1-006-4	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligible contact information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBLE_CONTACT_INFORMATION ELG00004 by keeping records that satisfy the following criteria:1a. ELIGIBLE-ADDR-EFF-DATE <= last day of the DQ report month2a. ELIGIBLE-ADDR-END-DATE >= last day of the DQ report month OR missingOR1b. ELIGIBLE-ADDR-EFF-DATE is missing2b. ELIGIBLE-ADDR-END-DATE is missingSTEP 3: Non-missing county code for primary addressOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. ELIGIBLE-COUNTY-CODE non-missing2. ELIGIBLE_ADDRESS_TYPE = "01"STEP 4: Percent eligible county code for the current month1. For each distinct value of county code, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Set the total number of unique MSIS IDs across all valid values of county code as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3. 3. For each distinct value of county code, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count.STEP 5: Percent eligible county code for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of county code, set the percent of county code for the previous month as Percent_Prior_Month_1. STEP 6: Calculate change between monthsFor each frequency percent, calculate Frequency_Change as the absolute value of (Percent_Current_Month – Percent_Prior_Month_1) / 2. Note that Frequency_Change is a vector of frequencies.STEP 7: Calculate index of dissimilarityCalculate the index of dissimilarity by summing Frequency_Change across all frequencies and dividing by 100	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligible contact information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBLE_CONTACT_INFORMATION ELG00004 by keeping records that satisfy the following criteria:1a. ELIGIBLE-ADDR-EFF-DATE <= last day of the DQ report month2a. ELIGIBLE-ADDR-END-DATE >= last day of the DQ report month OR missingOR1b. ELIGIBLE-ADDR-EFF-DATE is missing2b. ELIGIBLE-ADDR-END-DATE is missingSTEP 3: Non-missing county code for primary addressOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. ELIGIBLE-COUNTY-CODE non-missing2. ELIGIBLE_ADDRESS_TYPE = "01"STEP 4: Percent eligible county code for the current month1. For each distinct value of county code, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Sum the total number of unique MSIS IDs within each valid value of ethnicity and set as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3.3. For each distinct value of county code, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count.STEP 5: Percent eligible county code for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of county code, set the percent of county code for the previous month as Percent_Prior_Month_1. STEP 6: Calculate change between monthsFor each frequency percent, calculate Frequency_Change as the absolute value of (Percent_Current_Month – Percent_Prior_Month_1) / 2. Note that Frequency_Change is a vector of frequencies.STEP 7: Calculate index of dissimilarityCalculate the index of dissimilarity by summing Frequency_Change across all frequencies
10/07/2024	3.30.0	EL-10-001-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Non-missing plan typeOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. MANAGED-CARE-PLAN-TYPE non-missingSTEP 4: Percent plan type for the current month1. For each distinct value of plan type, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Set the total number of unique MSIS IDs across all valid values of plan type as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3. 3. For each distinct value of plan type, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count. STEP 5: Percent plan type for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of plan type, set the percent of plan type for the previous month as Percent_Prior_Month_1.STEP 6: Calculate change between monthsFor each frequency percent, calculate Frequency_Change as the absolute value of (Percent_Current_Month – Percent_Prior_Month_1) / 2. Note that Frequency_Change is a vector of frequencies.STEP 7: Calculate index of dissimilarityCalculate the index of dissimilarity by summing Frequency_Change across all frequencies and dividing by 100	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Non-missing plan typeOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. MANAGED-CARE-PLAN-TYPE non-missingSTEP 4: Percent plan type for the current month1. For each distinct value of plan type, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Sum the total number of unique MSIS IDs within each valid value of ethnicity and set as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3.3. For each distinct value of plan type, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count. STEP 5: Percent plan type for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of plan type, set the percent of plan type for the previous month as Percent_Prior_Month_1.STEP 6: Calculate change between monthsFor each frequency percent, calculate Frequency_Change as the absolute value of (Percent_Current_Month – Percent_Prior_Month_1) / 2. Note that Frequency_Change is a vector of frequencies.STEP 7: Calculate index of dissimilarityCalculate the index of dissimilarity by summing Frequency_Change across all frequencies
10/07/2024	3.30.0	Data Quality Measures	UPDATE	Version text	3.12.0	3.12.1
06/19/2024	3.27.0	RULE-7381	UPDATE	Measure name	% of distinct MSIS IDs with only missing values for IMMIGRATION-STATUS	% of record segments with missing Immigration Status
03/27/2024	3.22.0	RULE-7381	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7380	UPDATE	Measure name	% of distinct MSIS IDs with only missing values for CITIZENSHIP-IND	% of record segments with missing Citizenship Indicator
03/27/2024	3.22.0	RULE-7380	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7528	UPDATE	Measure name	% of MSIS IDs with an IMMIGRATION-STATUS = 8 (U.S. Citizen) but CITIZENSHIP-IND does not equal 1	% of record segments with an IMMIGRATION-STATUS = 8 (Not applicable) but CITIZENSHIP-IND does not equal 1 or 2 (U.S. Citizen or U.S. National)
03/27/2024	3.22.0	RULE-7528	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7529	UPDATE	Measure name	% of MSIS IDs with an alien restricted benefits code status (RESTRICTED-BENEFITS-CODE = 2) but a non-qualified alien immigration status (IMMIGRATION-STATUS not 1, 2, or 3)	% of record segments with an alien restricted benefits code status (RESTRICTED-BENEFITS-CODE = 2) but a non-qualified alien immigration status (IMMIGRATION-STATUS not 1, 2, or 3)
03/27/2024	3.22.0	RULE-7529	ADD	N/A		Created
06/19/2024	3.27.0	RULE-2157	UPDATE	Measure name	% of MSIS IDs with an alien restricted benefits code status (RESTRICTED-BENEFITS-CODE = 2) but CITIZENSHIP-IND = 1	% of record segments with an alien restricted benefits code status (RESTRICTED-BENEFITS-CODE = 2) but CITIZENSHIP-IND = 1 or 2 (U.S. Citizen or U.S. National)
06/19/2024	3.27.0	RULE-2051	UPDATE	Measure name	% of MSIS IDs with CITIZENSHIP-IND = 1 but IMMIGRATION-STATUS does not equal 8 (U.S. Citizen)	% of record segments with CITIZENSHIP-IND = 1 or 2 (U.S. Citizen or U.S. National) but IMMIGRATION-STATUS does not equal 8 (Not applicable)
03/27/2024	3.22.0	RULE-2051	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7980	UPDATE	Measure name	% of eligibles where zip code does not align with address state and is not missing	% of record segments where zip code does not align with address state and is not missing
03/27/2024	3.22.0	RULE-7980	ADD	N/A		Created
06/19/2024	3.27.0	RULE-7532	UPDATE	Measure name	% of eligibles where county code does not align with address state and is not missing	% of record segments where county code does not align with address state and is not missing
03/27/2024	3.22.0	RULE-7532	ADD	N/A		Created
03/27/2024	3.22.0	RULE-7364	ADD	N/A		Created
03/27/2024	3.22.0	RULE-7363	ADD	N/A		Created
03/27/2024	3.22.0	RULE-7362	ADD	N/A		Created
03/27/2024	3.22.0	RULE-7361	ADD	N/A		Created
03/27/2024	3.22.0	RULE-7360	ADD	N/A		Created
03/27/2024	3.22.0	RULE-7359	ADD	N/A		Created
03/27/2024	3.22.0	RULE-7358	ADD	N/A		Created
02/26/2025	3.34.0	EL-3-032-41	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EL-3-032-41	UPDATE	Threshold maximum	TBD	N/A
03/27/2024	3.22.0	EL-3-032-41	ADD	N/A		Created
02/26/2025	3.34.0	EL-3-031-40	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EL-3-031-40	UPDATE	Threshold maximum	TBD	N/A
03/27/2024	3.22.0	EL-3-031-40	ADD	N/A		Created
02/26/2025	3.34.0	EL-3-030-39	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EL-3-030-39	UPDATE	Threshold maximum	TBD	N/A
03/27/2024	3.22.0	EL-3-030-39	ADD	N/A		Created
02/26/2025	3.34.0	EL-6-047-47	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EL-6-047-47	UPDATE	Threshold maximum	TBD	N/A
03/27/2024	3.22.0	EL-6-047-47	ADD	N/A		Created
02/26/2025	3.34.0	EL-6-046-46	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EL-6-046-46	UPDATE	Threshold maximum	TBD	N/A
03/27/2024	3.22.0	EL-6-046-46	ADD	N/A		Created
02/26/2025	3.34.0	EL-6-045-45	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EL-6-045-45	UPDATE	Threshold maximum	TBD	N/A
03/27/2024	3.22.0	EL-6-045-45	ADD	N/A		Created
02/26/2025	3.34.0	EL-6-044-44	UPDATE	Priority	N/A	Medium
02/26/2025	3.34.0	EL-6-044-44	UPDATE	Category	N/A	Beneficiary eligibility
02/26/2025	3.34.0	EL-6-044-44	UPDATE	For ta comprehensive	No	TA- Inferential
02/26/2025	3.34.0	EL-6-044-44	UPDATE	For ta inferential	No	Yes
02/26/2025	3.34.0	EL-6-044-44	UPDATE	Ta min		0.001
02/26/2025	3.34.0	EL-6-044-44	UPDATE	Ta max		0.7
02/26/2025	3.34.0	EL-6-044-44	UPDATE	Threshold minimum	TBD	0.001
02/26/2025	3.34.0	EL-6-044-44	UPDATE	Threshold maximum	TBD	0.7
03/27/2024	3.22.0	EL-6-044-44	ADD	N/A		Created
02/26/2025	3.34.0	EL-6-043-43	UPDATE	Priority	N/A	Medium
02/26/2025	3.34.0	EL-6-043-43	UPDATE	Category	N/A	Beneficiary eligibility
02/26/2025	3.34.0	EL-6-043-43	UPDATE	For ta comprehensive	No	TA- Inferential
02/26/2025	3.34.0	EL-6-043-43	UPDATE	For ta inferential	No	Yes
02/26/2025	3.34.0	EL-6-043-43	UPDATE	Ta min		0.001
02/26/2025	3.34.0	EL-6-043-43	UPDATE	Ta max		0.4
02/26/2025	3.34.0	EL-6-043-43	UPDATE	Threshold minimum	TBD	0.001
02/26/2025	3.34.0	EL-6-043-43	UPDATE	Threshold maximum	TBD	0.4
03/27/2024	3.22.0	EL-6-043-43	ADD	N/A		Created
02/26/2025	3.34.0	EL-6-042-42	UPDATE	Priority	N/A	Medium
02/26/2025	3.34.0	EL-6-042-42	UPDATE	Category	N/A	Beneficiary eligibility
02/26/2025	3.34.0	EL-6-042-42	UPDATE	For ta comprehensive	No	TA- Inferential
02/26/2025	3.34.0	EL-6-042-42	UPDATE	For ta inferential	No	Yes
02/26/2025	3.34.0	EL-6-042-42	UPDATE	Ta min		0
02/26/2025	3.34.0	EL-6-042-42	UPDATE	Ta max		0.05
02/26/2025	3.34.0	EL-6-042-42	UPDATE	Threshold minimum	TBD	0
02/26/2025	3.34.0	EL-6-042-42	UPDATE	Threshold maximum	TBD	0.05
03/27/2024	3.22.0	EL-6-042-42	ADD	N/A		Created
02/26/2025	3.34.0	EL-6-040-40	UPDATE	Priority	N/A	High
02/26/2025	3.34.0	EL-6-040-40	UPDATE	Category	N/A	Beneficiary eligibility
02/26/2025	3.34.0	EL-6-040-40	UPDATE	For ta comprehensive	No	TA- Inferential
02/26/2025	3.34.0	EL-6-040-40	UPDATE	For ta inferential	No	Yes
02/26/2025	3.34.0	EL-6-040-40	UPDATE	Ta min		0.001
02/26/2025	3.34.0	EL-6-040-40	UPDATE	Ta max		0.1
02/26/2025	3.34.0	EL-6-040-40	UPDATE	Threshold minimum	TBD	0.001
02/26/2025	3.34.0	EL-6-040-40	UPDATE	Threshold maximum	TBD	0.1
02/26/2025	3.34.0	EL-6-040-40	UPDATE	Annotation	N/A	Calculate the percentage of MSIS IDs enrolled in the past 12 months with at least one gap in enrollment during that time period
02/26/2025	3.34.0	EL-6-040-40	UPDATE	Specification	N/A	STEP 1: Enrolled at any time within the past 12 monthsDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= 12 months prior to last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Enrollment Type is Medicaid or CHIPUsing the MSIS IDs that meet the criteria from STEP 1, further refine the population by keeping records with: 1. ENROLLMENT-TYPE = "1" or "2"STEP 3: Enrollment status by monthUsing the MSIS IDs that meet the criteria from STEP 2, for each month within the 12 month period identified in STEP 1, set Enrollment_Status = "1" where:1. ENROLLMENT-EFF-DATE <= first day of the month 2. ENROLLMENT-END-DATE >= last day of the month OR missingELSESet Enrollment_Status = "0"STEP 4: Identify enrollment gapsFor each month within the 12 month period identified in STEP 1, set Enrollment_Gap = "1" where:1. Enrollment_Status = "0" for the month2. There is any prior month within the 12 month period with Enrollment_Status = "1"3. There is any subsequent month within the 12 month period with Enrollment_Status = "1"ELSESet Enrollment_Gap = "0"STEP 5: Address multi-month enrollment gaps by keeping the enrollment gap status only for the earliest monthFor the months identified in STEP 4 where Enrollment_Status = "1", if the preceding month in the 12 month period also has Enrollment_Status = "1", set Enrollment_Status for the month = "0" STEP 6: Total count of enrollment gaps across 12 month periodFor each MSIS ID that meets the criteria from STEP 2, set Gap_Total = Count of months where Enrollment_Gap = "1"STEP 7: Count of MSIS IDs with an enrollment gapFor each MSIS ID that meets the criteria from STEP 2, further refine the population by keeping records where Gap_Total is greater than 0STEP 8: Calculate percentage for measureDivide the count of MSIS IDs from STEP 6 by the count of MSIS IDs from STEP 2
02/26/2025	3.34.0	EL-6-040-40	UPDATE	Focus area	N/A	Enrollment monitoring
03/27/2024	3.22.0	EL-6-040-40	ADD	N/A		Created
02/26/2025	3.34.0	EL-6-039-39	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EL-6-039-39	UPDATE	Threshold maximum	TBD	N/A
03/27/2024	3.22.0	EL-6-039-39	ADD	N/A		Created
02/26/2025	3.34.0	EL-6-038-38	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EL-6-038-38	UPDATE	Threshold maximum	TBD	N/A
03/27/2024	3.22.0	EL-6-038-38	ADD	N/A		Created
02/26/2025	3.34.0	ALL-16-023-23	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	ALL-16-023-23	UPDATE	Threshold maximum	TBD	N/A
03/27/2024	3.22.0	ALL-16-023-23	ADD	N/A		Created
02/26/2025	3.34.0	ALL-16-022-22	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	ALL-16-022-22	UPDATE	Threshold maximum	TBD	N/A
03/27/2024	3.22.0	ALL-16-022-22	ADD	N/A		Created
02/26/2025	3.34.0	ALL-16-021-21	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	ALL-16-021-21	UPDATE	Threshold maximum	TBD	N/A
03/27/2024	3.22.0	ALL-16-021-21	ADD	N/A		Created
02/26/2025	3.34.0	ALL-16-020-20	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	ALL-16-020-20	UPDATE	Threshold maximum	TBD	N/A
03/27/2024	3.22.0	ALL-16-020-20	ADD	N/A		Created
02/26/2025	3.34.0	ALL-16-019-19	UPDATE	Measure name	% of claims with IHS-SERVICE-IND = “1” (RX) not linked to any MSIS ID where AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR = “1”	% of claims with IHS-SERVICE-IND = “1” not linked to any MSIS ID where AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR = “1”
02/26/2025	3.34.0	ALL-16-019-19	UPDATE	Priority	N/A	Medium
02/26/2025	3.34.0	ALL-16-019-19	UPDATE	Category	N/A	Utilization
02/26/2025	3.34.0	ALL-16-019-19	UPDATE	For ta comprehensive	No	TA- Inferential
02/26/2025	3.34.0	ALL-16-019-19	UPDATE	For ta inferential	No	Yes
02/26/2025	3.34.0	ALL-16-019-19	UPDATE	Ta min		0
02/26/2025	3.34.0	ALL-16-019-19	UPDATE	Ta max		0.1
02/26/2025	3.34.0	ALL-16-019-19	UPDATE	Threshold minimum	TBD	0
02/26/2025	3.34.0	ALL-16-019-19	UPDATE	Threshold maximum	TBD	0.1
03/27/2024	3.22.0	ALL-16-019-19	ADD	N/A		Created
02/26/2025	3.34.0	ALL-16-018-18	UPDATE	Measure name	% of claims with IHS-SERVICE-IND = “1” (OT) not linked to any MSIS ID where AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR = “1”	% of claims with IHS-SERVICE-IND = “1” not linked to any MSIS ID where AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR = “1”
02/26/2025	3.34.0	ALL-16-018-18	UPDATE	Priority	N/A	Medium
02/26/2025	3.34.0	ALL-16-018-18	UPDATE	Category	N/A	Utilization
02/26/2025	3.34.0	ALL-16-018-18	UPDATE	For ta comprehensive	No	TA- Inferential
02/26/2025	3.34.0	ALL-16-018-18	UPDATE	For ta inferential	No	Yes
02/26/2025	3.34.0	ALL-16-018-18	UPDATE	Ta min		0
02/26/2025	3.34.0	ALL-16-018-18	UPDATE	Ta max		0.1
02/26/2025	3.34.0	ALL-16-018-18	UPDATE	Threshold minimum	TBD	0
02/26/2025	3.34.0	ALL-16-018-18	UPDATE	Threshold maximum	TBD	0.1
03/27/2024	3.22.0	ALL-16-018-18	ADD	N/A		Created
02/26/2025	3.34.0	ALL-16-017-17	UPDATE	Measure name	% of claims with IHS-SERVICE-IND = “1” (LT) not linked to any MSIS ID where AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR = “1”	% of claims with IHS-SERVICE-IND = “1” not linked to any MSIS ID where AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR = “1”
02/26/2025	3.34.0	ALL-16-017-17	UPDATE	Priority	N/A	Medium
02/26/2025	3.34.0	ALL-16-017-17	UPDATE	Category	N/A	Utilization
02/26/2025	3.34.0	ALL-16-017-17	UPDATE	For ta comprehensive	No	TA- Inferential
02/26/2025	3.34.0	ALL-16-017-17	UPDATE	For ta inferential	No	Yes
02/26/2025	3.34.0	ALL-16-017-17	UPDATE	Ta min		0
02/26/2025	3.34.0	ALL-16-017-17	UPDATE	Ta max		0.1
02/26/2025	3.34.0	ALL-16-017-17	UPDATE	Threshold minimum	TBD	0
02/26/2025	3.34.0	ALL-16-017-17	UPDATE	Threshold maximum	TBD	0.1
03/27/2024	3.22.0	ALL-16-017-17	ADD	N/A		Created
02/26/2025	3.34.0	ALL-16-016-16	UPDATE	Measure name	% of claims with IHS-SERVICE-IND = “1” (IP) not linked to any MSIS ID where AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR = “1”	% of claims with IHS-SERVICE-IND = “1” not linked to any MSIS ID where AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR = “1”
02/26/2025	3.34.0	ALL-16-016-16	UPDATE	Priority	N/A	Medium
02/26/2025	3.34.0	ALL-16-016-16	UPDATE	Category	N/A	Utilization
02/26/2025	3.34.0	ALL-16-016-16	UPDATE	For ta comprehensive	No	TA- Inferential
02/26/2025	3.34.0	ALL-16-016-16	UPDATE	For ta inferential	No	Yes
02/26/2025	3.34.0	ALL-16-016-16	UPDATE	Ta min		0
02/26/2025	3.34.0	ALL-16-016-16	UPDATE	Ta max		0.1
02/26/2025	3.34.0	ALL-16-016-16	UPDATE	Threshold minimum	TBD	0
02/26/2025	3.34.0	ALL-16-016-16	UPDATE	Threshold maximum	TBD	0.1
03/27/2024	3.22.0	ALL-16-016-16	ADD	N/A		Created
02/26/2025	3.34.0	MIS-6-024_43	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	MIS-6-024_43	UPDATE	Threshold maximum	TBD	N/A
03/27/2024	3.22.0	MIS-6-024_43	ADD	N/A		Created
02/26/2025	3.34.0	MIS-6-024_42	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	MIS-6-024_42	UPDATE	Threshold maximum	TBD	N/A
03/27/2024	3.22.0	MIS-6-024_42	ADD	N/A		Created
10/07/2024	3.30.0	RULE-7379	UPDATE	Adjustment type	Original and Replacement	Non-void
10/07/2024	3.30.0	RULE-7378	UPDATE	Adjustment type	Original and Replacement	Non-void
10/07/2024	3.30.0	RULE-7377	UPDATE	Adjustment type	Original and Replacement	Non-void
10/07/2024	3.30.0	RULE-7376	UPDATE	Adjustment type	Original and Replacement	Non-void
10/07/2024	3.30.0	RULE-7375	UPDATE	Adjustment type	Original and Replacement	Non-void
10/07/2024	3.30.0	RULE-7374	UPDATE	Adjustment type	Original and Replacement	Non-void
10/07/2024	3.30.0	RULE-7373	UPDATE	Adjustment type	Original and Replacement	Non-void
10/07/2024	3.30.0	RULE-7372	UPDATE	Adjustment type	Original and Replacement	Non-void
09/12/2024	3.29.0	TPL.006.082	UPDATE	Coding requirement	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Situational	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Situational3. Value must be in ZIP Code List (VVL)
09/12/2024	3.29.0	PRV.003.052	UPDATE	Coding requirement	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Mandatory	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Mandatory3. Value must be in ZIP Code List (VVL)
09/12/2024	3.29.0	MCR.003.047	UPDATE	Coding requirement	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Mandatory	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)3. Value must be in ZIP Code List (VVL)2. Mandatory
09/12/2024	3.29.0	ELG.004.071	UPDATE	Coding requirement	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Mandatory	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Mandatory3. Value must be in ZIP Code List (VVL)
09/12/2024	3.29.0	COT.003.208	UPDATE	Coding requirement	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Conditional	3. Value must be in ZIP Code List (VVL)1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Conditional
09/12/2024	3.29.0	COT.003.203	UPDATE	Coding requirement	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Conditional	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)3. Value must be in ZIP Code List (VVL)2. Conditional
06/19/2024	3.27.0	Data Quality Measures	UPDATE	Version text	3.11.0	3.12.0
09/12/2024	3.29.0	CIP.002.291	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated End of Time Period value4. Value must be greater than or equal to associated Beginning Date of Service value5. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be equal to or greater than associated Date of Birth (ELG.002.024) value8. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated End of Time Period value4. Value must be greater than or equal to associated Beginning Date of Service value5. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be equal to or greater than associated Date of Birth (ELG.002.024) value8. Mandatory
09/12/2024	3.29.0	CIP.002.290	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated End of Time Period value4. Value must be less than or equal to associated Ending Date of Service value5. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be less than or equal to at least one of the eligible's Enrollment End Date (ELG.021.254) values8. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated End of Time Period value4. Value must be less than or equal to associated Ending Date of Service value5. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be less than or equal to at least one of the eligible's Enrollment End Date (ELG.021.254) values8. Mandatory
02/02/2024	3.18.0	RULE-7753	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7754	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7755	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7752	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7902	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7903	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7904	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7901	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7320	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7316	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7319	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7315	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7318	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7314	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7317	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7313	ADD	N/A		Created
03/27/2024	3.22.0	RULE-7751	UPDATE	Measure name	% of claim headers with missing Prescription Quantity Actual	% of claim lines with missing Prescription Quantity Actual
02/02/2024	3.18.0	RULE-7751	ADD	N/A		Created
03/27/2024	3.22.0	RULE-7817	UPDATE	Measure name	% of claim headers with missing Prescription Quantity Actual	% of claim lines with missing Prescription Quantity Actual
02/02/2024	3.18.0	RULE-7817	ADD	N/A		Created
03/27/2024	3.22.0	RULE-7750	UPDATE	Measure name	% of claim headers with missing Days Supply	% of claim lines with missing Days Supply
02/02/2024	3.18.0	RULE-7750	ADD	N/A		Created
03/27/2024	3.22.0	RULE-7816	UPDATE	Measure name	% of claim headers with missing Days Supply	% of claim lines with missing Days Supply
02/02/2024	3.18.0	RULE-7816	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7354	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7353	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7352	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7351	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7349	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7265	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7736	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7892	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7263	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7262	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7257	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7256	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7255	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7254	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7740	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7896	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7739	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7895	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7738	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7894	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7737	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7893	ADD	N/A		Created
12/18/2024	3.33.0	RULE-7370	UPDATE	Focus area	Unwinding	Enrollment monitoring
12/18/2024	3.33.0	RULE-7366	UPDATE	Focus area	Unwinding	Enrollment monitoring
12/18/2024	3.33.0	RULE-7423	UPDATE	Focus area	Unwinding	Enrollment monitoring
03/27/2024	3.22.0	EL-6-037-37	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: U.S. citizen immigration statusOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. IMMIGRATION-STATUS = "3"STEP 4: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missing"STEP 5: Restricted Benefits Code designationOf the MSIS IDs that meet the criteria from STEP 4, restrict to those where:1. RESTRICTED-BENEFITS-CODE is not “2” or "4"STEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 4	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: U.S. citizen immigration statusOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. IMMIGRATION-STATUS = "3"STEP 4: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missing"STEP 5: Restricted Benefits Code designationOf the MSIS IDs that meet the criteria from STEP 4, restrict to those where:1. RESTRICTED-BENEFITS-CODE is not “2” or "4"STEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3
12/18/2024	3.33.0	EL-3-019_1-34	UPDATE	Focus area	Unwinding	Enrollment monitoring
06/19/2024	3.27.0	MIS-86-020-20	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MIS-84-030-30	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MIS-82-017-17	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MIS-80-017-17	UPDATE	Focus area	Managed care	N/A
12/18/2024	3.33.0	RULE-7447	UPDATE	Focus area	Unwinding	Enrollment monitoring
12/18/2024	3.33.0	RULE-2135	UPDATE	Focus area	Unwinding	Enrollment monitoring
12/18/2024	3.33.0	EL-3-017-22	UPDATE	Focus area	Unwinding	Enrollment monitoring
12/18/2024	3.33.0	EL-15-002-2	UPDATE	Focus area	Unwinding	Enrollment monitoring
12/18/2024	3.33.0	EL-15-001-1	UPDATE	Focus area	Unwinding	Enrollment monitoring
03/26/2024	3.22.0	Data Quality Measures	UPDATE	Version text	3.10.1	3.11.0
03/26/2024	3.22.0	Data Quality Measures	UPDATE	Thresholds document	253	280
03/26/2024	3.22.0	Data Quality Measures	UPDATE	Measures specification	251	281
03/26/2024	3.22.0	Data Quality Measures	UPDATE	Threshold and measures combined	252	282
09/12/2024	3.29.0	COT.002.030	UPDATE	Coding requirement	1. When populated, a Diagnosis Code Flag is required2. If associated Diagnosis Code Flag value is "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value is "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must be a minimum of 3 characters5. Value must not contain a decimal point6. If associated Diagnosis Code Flag value is '"1" (ICD-9), value must not exceed 5 characters7. If associated Diagnosis Code Flag value is "2" (ICD-10), value must not exceed 7 characters8. When there is more than one diagnosis code on a claim, each value must be unique9. Conditional10. When populated, value cannot equal Diagnosis Code 1 (COT.002.027)11. When Diagnosis Code 1 (COT.002.027) is not populated, value should not be populated	1. When populated, a Diagnosis Code Flag is required2. If associated Diagnosis Code Flag value is "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value is "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must be a minimum of 3 characters5. Value must not contain a decimal point6. If associated Diagnosis Code Flag value is "1" (ICD-9), value must not exceed 5 characters7. If associated Diagnosis Code Flag value is "2" (ICD-10), value must not exceed 7 characters8. When there is more than one diagnosis code on a claim, each value must be unique9. Conditional10. When populated, value cannot equal Diagnosis Code 1 (COT.002.027)11. When Diagnosis Code 1 (COT.002.027) is not populated, value should not be populated
09/12/2024	3.29.0	COT.002.027	UPDATE	Coding requirement	1. When populated, a Diagnosis Code Flag is required2. If associated Diagnosis Code Flag value is "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value is "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must be a minimum of 3 characters5. Value must not contain a decimal point6. If associated Diagnosis Code Flag value is '"1" (ICD-9), value must not exceed 5 characters7. If associated Diagnosis Code Flag value is "2" (ICD-10), value must not exceed 7 characters8. When there is more than one diagnosis code on a claim, each value must be unique9. Conditional10. If Type of Claim (COT.002.037) is in ("1", "3", "A", "C", "U", "W") then Diagnosis Code 1 (COT.002.027) must be populated.	1. When populated, a Diagnosis Code Flag is required2. If associated Diagnosis Code Flag value is "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value is "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must be a minimum of 3 characters5. Value must not contain a decimal point6. If associated Diagnosis Code Flag value is "1" (ICD-9), value must not exceed 5 characters7. If associated Diagnosis Code Flag value is "2" (ICD-10), value must not exceed 7 characters8. When there is more than one diagnosis code on a claim, each value must be unique9. Conditional10. If Type of Claim (COT.002.037) is in [1,3,A,C,U,W] then Diagnosis Code 1 (COT.002.027) must be populated
09/12/2024	3.29.0	CLT.002.029	UPDATE	Coding requirement	1. When populated, a Diagnosis Code Flag is required2. If associated Diagnosis Code Flag value is "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value is "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must be a minimum of 3 characters5. Value must not contain a decimal point6. If associated Diagnosis Code Flag value is '"1" (ICD-9), value must not exceed 5 characters7. If associated Diagnosis Code Flag value is "2" (ICD-10), value must not exceed 7 characters8. When there is more than one diagnosis code on a claim, each value must be unique9. Conditional10. If Type of Claim (CLT.002.052) in ("1", "3", "A", "C", "U", "W") then value must be populated.	1. When populated, a Diagnosis Code Flag is required2. If associated Diagnosis Code Flag value is "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value is "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must be a minimum of 3 characters5. Value must not contain a decimal point6. If associated Diagnosis Code Flag value is '"1" (ICD-9), value must not exceed 5 characters7. If associated Diagnosis Code Flag value is "2" (ICD-10), value must not exceed 7 characters8. When there is more than one diagnosis code on a claim, each value must be unique9. Conditional10. If Type of Claim (CLT.002.052) in [1,3,A,C,U,W] then value must be populated
09/12/2024	3.29.0	CIP.002.056	UPDATE	Coding requirement	1. When populated, a Diagnosis Code Flag is required2. If associated Diagnosis Code Flag value is "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value is "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must be a minimum of 3 characters5. Value must not contain a decimal point6. If associated Diagnosis Code Flag value is '"1" (ICD-9), value must not exceed 5 characters7. If associated Diagnosis Code Flag value is "2" (ICD-10), value must not exceed 7 characters8. When there is more than one diagnosis code on a claim, each value must be unique9. Conditional10. Value must not be populated when Diagnosis Code 8 (CIP.002.053) is not populated	1. When populated, a Diagnosis Code Flag is required10. Value must not be populated when Diagnosis Code 8 (CIP.002.053) is not populated2. If associated Diagnosis Code Flag value is "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value is "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must be a minimum of 3 characters5. Value must not contain a decimal point6. If associated Diagnosis Code Flag value is '"1" (ICD-9), value must not exceed 5 characters7. If associated Diagnosis Code Flag value is "2" (ICD-10), value must not exceed 7 characters8. When there is more than one diagnosis code on a claim, each value must be unique9. Conditional
09/12/2024	3.29.0	CIP.002.032	UPDATE	Coding requirement	1. When populated, a Diagnosis Code Flag is required2. If associated Diagnosis Code Flag value is "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value is "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must be a minimum of 3 characters5. Value must not contain a decimal point6. If associated Diagnosis Code Flag value is '"1" (ICD-9), value must not exceed 5 characters7. If associated Diagnosis Code Flag value is "2" (ICD-10), value must not exceed 7 characters8. When there is more than one diagnosis code on a claim, each value must be unique9. Conditional10. If Type of Claim (CIP.002.100) in ("1", "3", "A", "C", "U", "W") then value must be populated.	1. When populated, a Diagnosis Code Flag is required2. If associated Diagnosis Code Flag value is "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value is "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must be a minimum of 3 characters5. Value must not contain a decimal point6. If associated Diagnosis Code Flag value is '"1" (ICD-9), value must not exceed 5 characters7. If associated Diagnosis Code Flag value is "2" (ICD-10), value must not exceed 7 characters8. When there is more than one diagnosis code on a claim, each value must be unique9. Conditional10. If Type of Claim (CIP.002.100) in [1,3,A,C,U,W] then value must be populated
11/15/2023	3.16.0	RULE-7718	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7719	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7720	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7721	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7722	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7711	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7710	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7713	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7712	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7717	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7716	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7715	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7723	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7724	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7725	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7726	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7809	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7801	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7802	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7803	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7804	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7797	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7798	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7799	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7800	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7808	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7807	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7806	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7805	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7793	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7792	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7791	ADD	N/A		Created
11/15/2023	3.16.0	RULE-7790	ADD	N/A		Created
02/02/2024	3.18.0	RULE-7370	UPDATE	Focus area	N/A	Unwinding
02/02/2024	3.18.0	RULE-7196	UPDATE	Adjustment type	All Adjustment Types	Non-void
02/02/2024	3.18.0	MIS-85-023-23	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MIS-84-006-6	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MIS-84-002-2	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MIS-83-016-16	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MIS-83-001-1	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MIS-82-003-3	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MIS-82-002-2	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MIS-81-018-18	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MIS-81-003-3	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MIS-80-003-3	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MIS-80-002-2	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MIS-79-001-1	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MCR-19-008-2	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MCR-19-008-2	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	MCR-19-008-2	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MCR-19-008-2	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MCR-19-008-2	UPDATE	Ta min	0
02/02/2024	3.18.0	MCR-19-008-2	UPDATE	Ta max	0.05
02/02/2024	3.18.0	MCR-19-008-2	UPDATE	Focus area	Managed care	N/A
02/26/2025	3.34.0	MCR-19-006-4	UPDATE	Priority	N/A	Medium
02/26/2025	3.34.0	MCR-19-006-4	UPDATE	Category	N/A	Utilization
02/26/2025	3.34.0	MCR-19-006-4	UPDATE	For ta comprehensive	No	TA- Inferential
02/26/2025	3.34.0	MCR-19-006-4	UPDATE	For ta inferential	No	Yes
02/26/2025	3.34.0	MCR-19-006-4	UPDATE	Ta min		0
02/26/2025	3.34.0	MCR-19-006-4	UPDATE	Ta max		0.2
02/02/2024	3.18.0	MCR-17-008-2	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MCR-17-008-2	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	MCR-17-008-2	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MCR-17-008-2	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MCR-17-008-2	UPDATE	Ta min	0
02/02/2024	3.18.0	MCR-17-008-2	UPDATE	Ta max	0.05
02/02/2024	3.18.0	MCR-17-008-2	UPDATE	Focus area	Managed care	N/A
02/26/2025	3.34.0	MCR-14-024-2	UPDATE	Priority	N/A	Medium
02/26/2025	3.34.0	MCR-14-024-2	UPDATE	Category	N/A	Utilization
02/26/2025	3.34.0	MCR-14-024-2	UPDATE	For ta comprehensive	No	TA- Inferential
02/26/2025	3.34.0	MCR-14-024-2	UPDATE	For ta inferential	No	Yes
02/26/2025	3.34.0	MCR-14-024-2	UPDATE	Ta min		0.4
02/26/2025	3.34.0	MCR-14-024-2	UPDATE	Ta max		0.99
02/02/2024	3.18.0	FFS-16-008-2	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	FFS-16-008-2	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	FFS-16-008-2	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	FFS-16-008-2	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	FFS-16-008-2	UPDATE	Ta min	0
02/02/2024	3.18.0	FFS-16-008-2	UPDATE	Ta max	0.05
02/26/2025	3.34.0	FFS-16-007-4	UPDATE	Priority	N/A	Medium
02/26/2025	3.34.0	FFS-16-007-4	UPDATE	Category	N/A	Utilization
02/26/2025	3.34.0	FFS-16-007-4	UPDATE	For ta comprehensive	No	TA- Inferential
02/26/2025	3.34.0	FFS-16-007-4	UPDATE	For ta inferential	No	Yes
02/26/2025	3.34.0	FFS-16-007-4	UPDATE	Ta min		0
02/26/2025	3.34.0	FFS-16-007-4	UPDATE	Ta max		0.2
02/02/2024	3.18.0	FFS-14-008-2	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	FFS-14-008-2	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	FFS-14-008-2	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	FFS-14-008-2	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	FFS-14-008-2	UPDATE	Ta min	0
02/02/2024	3.18.0	FFS-14-008-2	UPDATE	Ta max	0.05
02/26/2025	3.34.0	FFS-11-024-2	UPDATE	Priority	N/A	Medium
02/26/2025	3.34.0	FFS-11-024-2	UPDATE	Category	N/A	Utilization
02/26/2025	3.34.0	FFS-11-024-2	UPDATE	For ta comprehensive	No	TA- Inferential
02/26/2025	3.34.0	FFS-11-024-2	UPDATE	For ta inferential	No	Yes
02/26/2025	3.34.0	FFS-11-024-2	UPDATE	Ta min		0.4
02/26/2025	3.34.0	FFS-11-024-2	UPDATE	Ta max		0.99
02/01/2024	3.18.0	Data Quality Measures	UPDATE	Version text	3.10.0	3.10.1
09/12/2024	3.29.0	CRX.002.099	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, value must have an associated Third Party Coinsurance Amount4. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, value must have an associated Third Party Coinsurance Amount4. Conditional
09/12/2024	3.29.0	CRX.002.025	UPDATE	Coding requirement	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [1,3,5,A,C,E,U,W,Y], then value must be in [0,1,4]3. If associated Type of Claim value is in [4,D,X], then value must be in [5,6]4. Value must be 1 character5. Mandatory6. If value is in [0,5,6], then associated Adjustment ICN must not be populated7. If value is in [4,1] then Adjustment ICN must be populated8. Value must equal "1", when associated Claim Status equals "686"
09/12/2024	3.29.0	COT.002.025	UPDATE	Coding requirement	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in[1,3,5,A,C,E,U,W,Y], then value must be in [0,1,4]3. If associated Type of Claim value is in [4,D,X], then value must be in [5,6]4. Value must be 1 character5. Mandatory6. If value is in [0,5,6], then associated Adjustment ICN must not be populated7. If value is in [4,1] then Adjustment ICN must be populated8. Value must equal "1", when associated Claim Status equals "686"
09/12/2024	3.29.0	CLT.002.025	UPDATE	Coding requirement	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [1,3,5,A,C,E,U,W,Y], then value must be in [0,1,4]3. If associated Type of Claim value is in [4,D,X], then value must be in [5,6]4. Value must be 1 character5. Mandatory6. If value is in [0,5,6], then associated Adjustment ICN must not be populated7. If value is in [4,1] then Adjustment ICN must be populated8. Value must equal "1", when associated Claim Status equals "686"
09/12/2024	3.29.0	CIP.002.026	UPDATE	Coding requirement	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [1,3,5,A,C,E,U,W,Y], then value must be in [0,1,4]3. If associated Type of Claim value is in [4,D,X], then value must be in [5,6]4. Value must be 1 character5. Mandatory6. If value is in [0,5,6], then associated Adjustment ICN must not be populated7. If value is in [4,1] then Adjustment ICN must be populated8. Value must equal "1", when associated Claim Status equals "686"
09/12/2024	3.29.0	TPL.001.012	UPDATE	Coding requirement	1. Value must be in SSN Indicator List (VVL)2. Value must be 1 character3. Mandatory4. When populated, value must equal SSN Indicator (ELG.001.012)	1. Value must be in SSN Indicator List (VVL)2. Value must be 1 character3. Mandatory
09/12/2024	3.29.0	COT.003.189	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ("Z","3","C",'W',"2","B","V","4","D","X") then value may match (PRV.005.081) Provider Identifier or4. When Type of Claim not in ("Z","3","C",'W',"2","B","V","4","D","X") then value may match (PRV.002.019) Submitting State Provider ID5. When Type of Claim in ["1","3","A","C"] then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in "01", "02", "03", "04", "05", "06"] (active)	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [Z,3,C,W,2,B,V,4,D,X], then value may match (PRV.005.081) Provider Identifier or4. When Type of Claim not in [Z,3,C,W,2,B,V,4,D,X], then value may match (PRV.002.019) Submitting State Provider ID5. When Type of Claim in [1,3,A,C] then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in [01,02,03,04,05,06] (active)
09/12/2024	3.29.0	ELG.005.091	UPDATE	Coding requirement	1. Value must be in SSI State Supplement Status Code List (VVL)2. Value must be 3 characters3. (individual not receiving Federal SSI)If value is "001" or "002", then SSI Status (ELG.005.092) must be "001" or "002"4. (Individual not receiving Federal SSI)If value is "001" or "002", then SSI Indicator (ELG.005.090) must be "1"5. Value must not be populated or must be "000" when SSI Status (ELG.005.092) is not populated or is "000"	1. Value must be in SSI State Supplement Status Code List (VVL)2. Value must be 3 characters3. (individual not receiving Federal SSI) If value is "001" or "002", then SSI Status (ELG.005.092) must be "001" or "002"4. (Individual not receiving Federal SSI)If value is "001" or "002", then SSI Indicator (ELG.005.090) must be "1"5. Value must not be populated or must be "000" when SSI Status (ELG.005.092) is not populated or is "000"
09/12/2024	3.29.0	CLT.003.212	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID5. When Type of Claim in ['1','3','A','C’] then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in ['01', '02', '03', '04', '05', '06'] (active)	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [Z,3,C,W,2,B,V,4,D,X] then value may match (PRV.005.081) Provider Identifier or4. When Type of Claim not in [Z,3,C,W,2,B,V,4,D,X] then value may match (PRV.002.019) Submitting State Provider ID
09/12/2024	3.29.0	CLT.002.150	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Split Claim Indicator List (VVL).4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Split Claim Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	CIP.003.260	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID5. When Type of Claim in ['1','3','A','C’] then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in ['01', '02', '03', '04', '05', '06'] (active)	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in (Z,3,C,W,2,B,V,4,D,X) then value may match (PRV.005.081) Provider Identifier or4. When Type of Claim not in (Z,3,C,W,2,B,V,4,D,X) then value may match (PRV.002.019) Submitting State Provider ID5. When Type of Claim in [1,3,A,C] then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in [01,02,03,04,05,06] (active)
09/12/2024	3.29.0	CIP.002.203	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Split Claim Indicator List (VVL).4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Split Claim Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	COT.003.190	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Claim (COT.002.037) not in ('3','C','W') then value must match Provider Identifier (PRV.005.081)5. Value must exist in the NPPES NPI data file	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When Type of Claim (COT.002.037) not in [3,C,W]. then value must match Provider Identifier (PRV.005.081)6. When Type of Claim is in [1,3,A,C], then value must be populated7.When Type of Claim is in [1,3,A,C] and value is not populated, Servicing Provider Number (COT.003.189) must be populated
09/12/2024	3.29.0	CLT.003.213	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Claim (CLT.002.052) not in ('3','C','W') then value must match Provider Identifier (PRV.005.081)5. Value must exist in the NPPES NPI data file	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. When Type of Claim (CLT.002.052) not in [3,C,W] then value must match Provider Identifier (PRV.005.081)
09/12/2024	3.29.0	CIP.003.261	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. Value must exist in the NPPES NPI data file5. When Type of Claim is in ['1','3','A','C'], then value must be populated	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When Type of Claim is in [1,3,A,C], then value must be populated
09/12/2024	3.29.0	CRX.002.075	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Mandatory4. Value must exist in the NPPES NPI data file5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Mandatory5. NPPES Entity Type Code associate with this NPI must equal '1' (Individual)
09/12/2024	3.29.0	CIP.003.265	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. Value must exist in the NPPES NPI data file	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When Type of Claim is in [1,3,A,C], then value must be populated
09/12/2024	3.29.0	COT.003.169	UPDATE	Coding requirement	1. When populated, there must be a corresponding Procedure Code Flag2. If associated Procedure Code Flag List (VVL) value indicates an CPT-4 encoding '01', then value must be a valid CPT-4 procedure code3. If associated Procedure Code Flag List (VVL) value indicates an "Other" encoding '10-87', then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code4. If associated Procedure Code Flag List (VVL) value indicates an HCPCS encoding '06', then value must be a valid HCPCS code5. Value must be 8 characters or less6. Value must be in Procedure Code List (VVL)7. Conditional	1. When populated, there must be a corresponding Procedure Code Flag2. If associated Procedure Code Flag List (VVL) value indicates an CPT-4 encoding "01", then value must be a valid CPT-4 procedure code3. If associated Procedure Code Flag List (VVL) value indicates "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list,and value must be a valid State-specific procedure code4. If associated Procedure Code Flag List (VVL) value indicates an HCPCS encoding "06", then value must be a valid HCPCS code5. Value must be 8 characters or less6. Value must be in Procedure Code List (VVL)7. Conditional
09/12/2024	3.29.0	CRX.002.101	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, must have an associated Third Party Copayment Amount4. Situational	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, must have an associated Third Party Copayment Amount4. Situational
11/15/2023	3.16.0	RULE-7411	UPDATE	Ta min	0.05	0
11/15/2023	3.16.0	RULE-7408	UPDATE	Ta min	0.01	0
11/15/2023	3.16.0	RULE-7407	UPDATE	Ta min	0.01	0
11/15/2023	3.16.0	RULE-7371	UPDATE	Ta min	0.02	0
11/15/2023	3.16.0	RULE-7370	UPDATE	Ta min	0.02	0
02/02/2024	3.18.0	RULE-7366	UPDATE	Focus area	N/A	Unwinding
02/02/2024	3.18.0	RULE-7423	UPDATE	Focus area	N/A	Unwinding
06/19/2024	3.27.0	MCR-59R-004-16	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-59R-003-15	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-59R-002-14	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-59R-001-13	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-56R-001-1	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	EXP-41R-001-1	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	EXP-22R-009-9	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	EXP-37R-001-1-2	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	EXP-33R-001-1	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	EXP-29R-001-1	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-59P-004-16	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-59P-003-15	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-59P-002-14	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-59P-001-13	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-56P-001-1	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	EXP-41P-001-1	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	EXP-22P-009-9	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	EXP-37P-001-1-2	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	EXP-33P-001-1	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	EXP-29P-001-1	UPDATE	Focus area	Managed care	N/A
11/15/2023	3.16.0	RULE-7641	UPDATE	Measure name	% of record segments with a valid Dual Eligible Code that have a missing value for Medicare HIC Number or Medicare Beneficiary Identifier for the same period of time	% of record segments with a valid Dual Eligible Code that have a missing value for Medicare HIC Number and Medicare Beneficiary Identifier for the same period of time
06/19/2024	3.27.0	ALL-16-015-15	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	ALL-16-015-15	UPDATE	Threshold maximum	TBD	N/A
06/19/2024	3.27.0	ALL-16-015-15	UPDATE	Annotation	Calculate the percentage of RX claim lines with XIX-MBESCBES-CATEGORY-OF-SERVICE = “14”, “35”, “42” or “44” that are linked to an MSIS ID where SEX is "M"	N/A
06/19/2024	3.27.0	ALL-16-015-15	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the line level by importing lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Non-missing prescription fill dateOf the claim lines that meet the criteria from STEP 1, restrict to non-missing PRESCRIPTION-FILL-DATESTEP 3: Link claims to primary demographicsKeep all claims from STEP 2 for which the MSIS ID on the claim is also found on a PRIMARY-DEMOGRAPHICS-ELG00002 segment, where the following is true:1. Claims PRESCRIPTION-FILL-DATE>= PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE 2. Claims PRESCRIPTION-FILL-DATE<= PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE OR missingSTEP 4: Non-missing SexOf the claims that meet the criteria from STEP 3, restrict to non-missing SEXSTEP 5: XIX category of serviceOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. XIX-MBESCBES-CATEGORY-OF-SERVICE = “14”, “35”, “42” or “44”STEP 6: Sex is "M"Of claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. SEX = "M"STEP 7: Calculate percentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5	N/A
06/19/2024	3.27.0	ALL-16-014-14	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	ALL-16-014-14	UPDATE	Threshold maximum	TBD	N/A
06/19/2024	3.27.0	ALL-16-014-14	UPDATE	Annotation	Calculate the percentage of OT claim lines with XIX-MBESCBES-CATEGORY-OF-SERVICE = “14”, “35”, “42” or “44” that are linked to an MSIS ID where SEX is "M"	N/A
06/19/2024	3.27.0	ALL-16-014-14	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Non-missing beginning date of serviceOf the claim lines that meet the criteria from STEP 1, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 3: Link claims to primary demographicsKeep all claims from STEP 2 for which the MSIS ID on the claim is also found on a PRIMARY-DEMOGRAPHICS-ELG00002 segment, where the following is true:1. Claims BEGINNING-DATE-OF-SERVICE>= PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE 2. Claims BEGINNING-DATE-OF-SERVICE <= PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE OR missingSTEP 4: Non-missing SexOf the claims that meet the criteria from STEP 3, restrict to non-missing SEXSTEP 5: XIX category of serviceOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. XIX-MBESCBES-CATEGORY-OF-SERVICE = “14”, “35”, “42” or “44”STEP 6: Sex is "M"Of claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. SEX = "M"STEP 7: Calculate percentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5	N/A
06/19/2024	3.27.0	ALL-16-013-13	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	ALL-16-013-13	UPDATE	Threshold maximum	TBD	N/A
06/19/2024	3.27.0	ALL-16-013-13	UPDATE	Annotation	Calculate the percentage of LT claim lines with XIX-MBESCBES-CATEGORY-OF-SERVICE = “14”, “35”, “42” or “44” that are linked to an MSIS ID where SEX is "M"	N/A
06/19/2024	3.27.0	ALL-16-013-13	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the line level by importing lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Non-missing beginning date of serviceOf the claim lines that meet the criteria from STEP 1, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 3: Link claims to primary demographicsKeep all claims from STEP 2 for which the MSIS ID on the claim is also found on a PRIMARY-DEMOGRAPHICS-ELG00002 segment, where the following is true:1. Claims BEGINNING-DATE-OF-SERVICE>= PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE 2. Claims BEGINNING-DATE-OF-SERVICE <= PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE OR missingSTEP 4: Non-missing SexOf the claims that meet the criteria from STEP 3, restrict to non-missing SEXSTEP 5: XIX category of serviceOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. XIX-MBESCBES-CATEGORY-OF-SERVICE = “14”, “35”, “42” or “44”STEP 6: Sex is "M"Of claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. SEX = "M"STEP 7: Calculate percentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5	N/A
06/19/2024	3.27.0	ALL-16-012-12	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	ALL-16-012-12	UPDATE	Threshold maximum	TBD	N/A
06/19/2024	3.27.0	ALL-16-012-12	UPDATE	Annotation	Calculate the percentage of IP claim lines with XIX-MBESCBES-CATEGORY-OF-SERVICE= “14”, “35”, “42” or “44” that are linked to an MSIS ID where SEX is "M"	N/A
06/19/2024	3.27.0	ALL-16-012-12	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Non-missing admission dateOf the claim lines that meet the criteria from STEP 1, restrict to non-missing ADMISSION-DATESTEP 3: Link claims to primary demographicsKeep all claims from STEP 2 for which the MSIS ID on the claim is also found on a PRIMARY-DEMOGRAPHICS-ELG00002 segment, where the following is true:1. Claims ADMISSION-DATE>= PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE 2. Claims ADMISSION-DATE <= PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE OR missingSTEP 4: Non-missing SexOf the claims that meet the criteria from STEP 3, restrict to non-missing SEXSTEP 5: XIX category of serviceOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. XIX-MBESCBES-CATEGORY-OF-SERVICE = “14”, “35”, “42” or “44”STEP 6: Sex is "M"Of claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. SEX = "M"STEP 7: Calculate percentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5	N/A
06/19/2024	3.27.0	ALL-16-011-11	UPDATE	Measure name	% of claim lines with TYPE-OF-SERVICE= “025” or “085” (LT) linked to an MSIS ID where SEX = “M”	% of claim lines with TYPE-OF-SERVICE= “025” or “085” (OT) linked to an MSIS ID where SEX = “M”
06/19/2024	3.27.0	ALL-16-011-11	UPDATE	Annotation	Calculate the percentage of LT claim lines with TYPE-OF-SERVICE= "025" or "085” that are linked to an MSIS ID where SEX is "M"	Calculate the percentage of OT claim lines with TYPE-OF-SERVICE= "025" or "085” that are linked to an MSIS ID where SEX is "M"
06/19/2024	3.27.0	ALL-16-011-11	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the line level by importing lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Non-missing beginning date of serviceOf the claim lines that meet the criteria from STEP 1, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 3: Link claims to primary demographicsKeep all claims from STEP 2 for which the MSIS ID on the claim is also found on a PRIMARY-DEMOGRAPHICS-ELG00002 segment, where the following is true:1. Claims BEGINNING-DATE-OF-SERVICE>= PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE 2. Claims BEGINNING-DATE-OF-SERVICE <= PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE OR missingSTEP 4: Non-missing SexOf the claims that meet the criteria from STEP 3, restrict to non-missing SEXSTEP 5: Nurse-midwife service or Prenatal care and pre-pregnancy family planning services and supplies type of serviceOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-SERVICE = "025" or "085"STEP 6: Sex is "M"Of claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. SEX = "M"STEP 7: Calculate percentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Non-missing beginning date of serviceOf the claim lines that meet the criteria from STEP 1, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 3: Link claims to primary demographicsKeep all claims from STEP 2 for which the MSIS ID on the claim is also found on a PRIMARY-DEMOGRAPHICS-ELG00002 segment, where the following is true:1. Claims BEGINNING-DATE-OF-SERVICE>= PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE 2. Claims BEGINNING-DATE-OF-SERVICE <= PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE OR missingSTEP 4: Non-missing SexOf the claims that meet the criteria from STEP 3, restrict to non-missing SEXSTEP 5: Nurse-midwife service or Prenatal care and pre-pregnancy family planning services and supplies type of serviceOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-SERVICE = "025" or "085"STEP 6: Sex is "M"Of claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. SEX = "M"STEP 7: Calculate percentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5
06/19/2024	3.27.0	ALL-16-010-10	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	ALL-16-010-10	UPDATE	Threshold maximum	TBD	N/A
06/19/2024	3.27.0	ALL-16-010-10	UPDATE	Annotation	Calculate the percentage of RX claim lines with TYPE-OF-SERVICE= “086” that are linked to an MSIS ID where SEX is "M"	N/A
06/19/2024	3.27.0	ALL-16-010-10	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the line level by importing lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Non-missing prescription fill dateOf the claim lines that meet the criteria from STEP 1, restrict to non-missing PRESCRIPTION-FILL-DATESTEP 3: Link claims to primary demographicsKeep all claims from STEP 2 for which the MSIS ID on the claim is also found on a PRIMARY-DEMOGRAPHICS-ELG00002 segment, where the following is true:1. Claims PRESCRIPTION-FILL-DATE>= PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE 2. Claims PRESCRIPTION-FILL-DATE<= PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE OR missingSTEP 4: Non-missing SexOf the claims that meet the criteria from STEP 3, restrict to non-missing SEXSTEP 5: Other Pregnancy-related Procedures type of serviceOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-SERVICE = "086"STEP 6: Sex is "M"Of claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. SEX = "M"STEP 7: Calculate percentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5	N/A
06/19/2024	3.27.0	ALL-16-009-9	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	ALL-16-009-9	UPDATE	Threshold maximum	TBD	N/A
06/19/2024	3.27.0	ALL-16-009-9	UPDATE	Annotation	Calculate the percentage of IP claim lines with TYPE-OF-SERVICE= “086” that are linked to an MSIS ID where SEX is "M"	N/A
06/19/2024	3.27.0	ALL-16-009-9	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Non-missing admission dateOf the claim lines that meet the criteria from STEP 1, restrict to non-missing ADMISSION-DATESTEP 3: Link claims to primary demographicsKeep all claims from STEP 2 for which the MSIS ID on the claim is also found on a PRIMARY-DEMOGRAPHICS-ELG00002 segment, where the following is true:1. Claims ADMISSION-DATE>= PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE 2. Claims ADMISSION-DATE <= PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE OR missingSTEP 4: Non-missing SexOf the claims that meet the criteria from STEP 3, restrict to non-missing SEXSTEP 5: Other Pregnancy-related Procedures type of serviceOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-SERVICE = "086"STEP 6: Sex is "M"Of claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. SEX = "M"STEP 7: Calculate percentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5	N/A
06/19/2024	3.27.0	EL-3-029-38	UPDATE	Priority	N/A	High
06/19/2024	3.27.0	EL-3-029-38	UPDATE	Category	N/A	Beneficiary eligibility
06/19/2024	3.27.0	EL-3-029-38	UPDATE	For ta comprehensive	No	TA- Inferential
06/19/2024	3.27.0	EL-3-029-38	UPDATE	For ta inferential	No	Yes
06/19/2024	3.27.0	EL-3-029-38	UPDATE	Ta min		0
06/19/2024	3.27.0	EL-3-029-38	UPDATE	Ta max		0.05
06/19/2024	3.27.0	EL-3-029-38	UPDATE	Threshold minimum	TBD	0
06/19/2024	3.27.0	EL-3-029-38	UPDATE	Threshold maximum	TBD	0.05
06/19/2024	3.27.0	EL-3-028-37	UPDATE	Priority	N/A	High
06/19/2024	3.27.0	EL-3-028-37	UPDATE	Category	N/A	Beneficiary demographics
06/19/2024	3.27.0	EL-3-028-37	UPDATE	For ta comprehensive	No	TA- Inferential
06/19/2024	3.27.0	EL-3-028-37	UPDATE	For ta inferential	No	Yes
06/19/2024	3.27.0	EL-3-028-37	UPDATE	Ta min		0
06/19/2024	3.27.0	EL-3-028-37	UPDATE	Ta max		0.05
06/19/2024	3.27.0	EL-3-028-37	UPDATE	Threshold minimum	TBD	0
06/19/2024	3.27.0	EL-3-028-37	UPDATE	Threshold maximum	TBD	0.05
06/19/2024	3.27.0	EXP-13-004_1-7	UPDATE	Priority	N/A	High
06/19/2024	3.27.0	EXP-13-004_1-7	UPDATE	For ta comprehensive	No	TA- Inferential
06/19/2024	3.27.0	EXP-13-004_1-7	UPDATE	For ta inferential	No	Yes
06/19/2024	3.27.0	EXP-13-004_1-7	UPDATE	Ta min		0
06/19/2024	3.27.0	EXP-13-004_1-7	UPDATE	Ta max		0.1
06/19/2024	3.27.0	EXP-13-004_1-7	UPDATE	Threshold minimum	TBD	0
06/19/2024	3.27.0	EXP-13-004_1-7	UPDATE	Threshold maximum	TBD	0.1
06/19/2024	3.27.0	EXP-13-003_1-6	UPDATE	Priority	N/A	High
06/19/2024	3.27.0	EXP-13-003_1-6	UPDATE	For ta comprehensive	No	TA- Inferential
06/19/2024	3.27.0	EXP-13-003_1-6	UPDATE	For ta inferential	No	Yes
06/19/2024	3.27.0	EXP-13-003_1-6	UPDATE	Ta min		0
06/19/2024	3.27.0	EXP-13-003_1-6	UPDATE	Ta max		0.1
06/19/2024	3.27.0	EXP-13-003_1-6	UPDATE	Threshold minimum	TBD	0
06/19/2024	3.27.0	EXP-13-003_1-6	UPDATE	Threshold maximum	TBD	0.1
11/15/2023	3.16.0	RULE-7706	UPDATE	Adjustment type	Original	Non-void
11/15/2023	3.16.0	RULE-7702	UPDATE	Adjustment type	Original	Non-void
11/15/2023	3.16.0	RULE-7201	UPDATE	Adjustment type	Non-void	All Adjustment Types
11/15/2023	3.16.0	RULE-7200	UPDATE	Adjustment type	Non-void	All Adjustment Types
11/15/2023	3.16.0	RULE-7199	UPDATE	Adjustment type	Non-void	All Adjustment Types
11/15/2023	3.16.0	RULE-7198	UPDATE	Adjustment type	Non-void	All Adjustment Types
11/15/2023	3.16.0	RULE-7197	UPDATE	Adjustment type	Non-void	All Adjustment Types
11/15/2023	3.16.0	RULE-7196	UPDATE	Adjustment type	Non-void	All Adjustment Types
11/15/2023	3.16.0	RULE-7195	UPDATE	Adjustment type	Non-void	All Adjustment Types
11/15/2023	3.16.0	RULE-7194	UPDATE	Adjustment type	Non-void	All Adjustment Types
06/19/2024	3.27.0	MCR-9-019-21	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	MCR-9-019-21	UPDATE	Threshold maximum	TBD	N/A
06/19/2024	3.27.0	MCR-9-019-21	UPDATE	Annotation	Calculate the percentage of Comprehensive MCO capitation payments with a non-missing plan id that do not have a corresponding managed care participation Comprehensive MCO plan	N/A
06/19/2024	3.27.0	MCR-9-019-21	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2"2. ADJUSTMENT-IND = "0"STEP 3: Type of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "119"STEP 4: Non-missing plan idOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. PLAN-ID-NUMBER is not missingSTEP 5: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 6: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 5, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 7: No managed care participation Comprehensive MCO planOf the claim lines that meet the criteria from STEP 4, further restrict them by attempting to merge them with the data from STEP 6 and keeping those that satisfy the following criteria:1a. PLAN-ID-NUMBER = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal “01”, “04”, or “17” for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PLAN-ID-NUMBER = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 8: Calculate the percentage for the measureDivide the count of claims from STEP 7 by the count of claims from STEP 4	N/A
06/19/2024	3.27.0	MCR-9-019-21	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-9-018-20	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	MCR-9-018-20	UPDATE	Threshold maximum	TBD	N/A
06/19/2024	3.27.0	MCR-9-018-20	UPDATE	Annotation	Calculate the percentage of PHP capitation payments with a non-missing plan id that do not have a corresponding managed care participation PHP plan	N/A
06/19/2024	3.27.0	MCR-9-018-20	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2"2. ADJUSTMENT-IND = "0"STEP 3: Type of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "122"STEP 4: Non-missing plan idOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. PLAN-ID-NUMBER is not missingSTEP 5: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 6: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 5, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 7: No managed care participation PHP planOf the claim lines that meet the criteria from STEP 4, further restrict them by attempting to merge them with the data from STEP 6 and keeping those that satisfy the following criteria:1a. PLAN-ID-NUMBER = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal (“05”, “06”, “07”, “08”, “09”, “10”, “11”, “12”, “13”, “14”, “15”, “16”, “18”, “19”) for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PLAN-ID-NUMBER = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 8: Calculate the percentage for the measureDivide the count of claims from STEP 7 by the count of claims from STEP 4	N/A
06/19/2024	3.27.0	MCR-9-018-20	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-13-019-21	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	MCR-13-019-21	UPDATE	Threshold maximum	TBD	N/A
06/19/2024	3.27.0	MCR-13-019-21	UPDATE	Annotation	Calculate the percentage of Comprehensive MCO capitation payments with a non-missing plan ID that do not have a corresponding managed care participation Comprehensive MCO plan	N/A
06/19/2024	3.27.0	MCR-13-019-21	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B"2. ADJUSTMENT-IND = "0"STEP 3: Type of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "119"STEP 4: Non-missing plan idOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. PLAN-ID-NUMBER is not missingSTEP 5: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 6: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 5, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 7: No managed care participation Comprehensive MCO planOf the claim lines that meet the criteria from STEP 4, further restrict them by attempting to merge them with the data from STEP 6 and keeping those that satisfy the following criteria:1a. PLAN-ID-NUMBER = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal “01”, “04”, or “17” for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PLAN-ID-NUMBER = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 8: Calculate the percentage for the measureDivide the count of claims from STEP 7 by the count of claims from STEP 4	N/A
06/19/2024	3.27.0	MCR-13-019-21	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-13-018-20	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	MCR-13-018-20	UPDATE	Threshold maximum	TBD	N/A
06/19/2024	3.27.0	MCR-13-018-20	UPDATE	Annotation	Calculate the percentage of PHP capitation payments with a non-missing plan ID that do not have a corresponding managed care participation PHP plan	N/A
06/19/2024	3.27.0	MCR-13-018-20	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B"2. ADJUSTMENT-IND = "0"STEP 3: Type of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "122"STEP 4: Non-missing plan idOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. PLAN-ID-NUMBER is not missingSTEP 5: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 6: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 5, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 7: No managed care participation PHP planOf the claim lines that meet the criteria from STEP 4, further restrict them by attempting to merge them with the data from STEP 6 and keeping those that satisfy the following criteria:1a. PLAN-ID-NUMBER = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal (“05”, “06”, “07”, “08”, “09”, “10”, “11”, “12”, “13”, “14”, “15”, “16”, “18”, “19”) for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PLAN-ID-NUMBER = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 8: Calculate the percentage for the measureDivide the count of claims from STEP 7 by the count of claims from STEP 4	N/A
06/19/2024	3.27.0	MCR-13-018-20	UPDATE	Focus area	Managed care	N/A
11/15/2023	3.16.0	EXP-11-160_1-163	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims that meet the criteria from STEP 2, count records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Billed amount $0Of the claims that meet the criteria from STEP 3, count records with1. TOT-BILLED-AMT = "0"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims that meet the criteria from STEP 2, count records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Billed amount $0Of the claims that meet the criteria from STEP 3, count records with1. BILLED-AMT = "0"STEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
02/02/2024	3.18.0	EL-6-037-37	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: U.S. citizen immigration statusOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. IMMIGRATION-STATUS = "3"STEP 4: Restricted Benefits Code designationOf the MSIS IDs that meet the criteria from STEP 3, restrict to those where:1. RESTRICTED-BENEFITS-CODE is not “2” or "4"STEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: U.S. citizen immigration statusOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. IMMIGRATION-STATUS = "3"STEP 4: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missing"STEP 5: Restricted Benefits Code designationOf the MSIS IDs that meet the criteria from STEP 4, restrict to those where:1. RESTRICTED-BENEFITS-CODE is not “2” or "4"STEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 4
02/02/2024	3.18.0	EL-1-038-45	UPDATE	Annotation	N/A	Calculate the percentage of eligibles with English as a primary language
02/02/2024	3.18.0	EL-1-038-45	UPDATE	Specification	N/A	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Primary language code is not missingOf the MSIS IDs that meet the criteria from STEP 2, restrict to segments where:1. PRIMARY-LANGUAGE-CODE is not missingSTEP 4: Primary language code is EnglishOf the MSIS IDs that meet the criteria from STEP 3, restrict to segments where:1. PRIMARY-LANGUAGE-CODE = "ENG"STEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3
12/18/2024	3.33.0	RULE-7460	UPDATE	Priority	High	N/A
12/18/2024	3.33.0	RULE-7460	UPDATE	Category	Utilization	N/A
12/18/2024	3.33.0	RULE-7460	UPDATE	For ta comprehensive	TA- Inferential	No
12/18/2024	3.33.0	RULE-7460	UPDATE	For ta inferential	Yes	No
12/18/2024	3.33.0	RULE-7460	UPDATE	Ta min	0
12/18/2024	3.33.0	RULE-7460	UPDATE	Ta max	0.001
12/18/2024	3.33.0	RULE-7446	UPDATE	Priority	High	N/A
12/18/2024	3.33.0	RULE-7446	UPDATE	Category	Provider enrollment	N/A
12/18/2024	3.33.0	RULE-7446	UPDATE	For ta comprehensive	TA- Inferential	No
12/18/2024	3.33.0	RULE-7446	UPDATE	For ta inferential	Yes	No
12/18/2024	3.33.0	RULE-7446	UPDATE	Ta min	0
12/18/2024	3.33.0	RULE-7446	UPDATE	Ta max	0.05
12/18/2024	3.33.0	RULE-7445	UPDATE	Priority	High	N/A
12/18/2024	3.33.0	RULE-7445	UPDATE	Category	Provider enrollment	N/A
12/18/2024	3.33.0	RULE-7445	UPDATE	For ta comprehensive	TA- Inferential	No
12/18/2024	3.33.0	RULE-7445	UPDATE	For ta inferential	Yes	No
12/18/2024	3.33.0	RULE-7445	UPDATE	Ta min	0
12/18/2024	3.33.0	RULE-7445	UPDATE	Ta max	0.05
12/18/2024	3.33.0	RULE-7444	UPDATE	Priority	High	N/A
12/18/2024	3.33.0	RULE-7444	UPDATE	Category	Provider enrollment	N/A
12/18/2024	3.33.0	RULE-7444	UPDATE	For ta comprehensive	TA- Inferential	No
12/18/2024	3.33.0	RULE-7444	UPDATE	For ta inferential	Yes	No
12/18/2024	3.33.0	RULE-7444	UPDATE	Ta min	0
12/18/2024	3.33.0	RULE-7444	UPDATE	Ta max	0.05
12/18/2024	3.33.0	RULE-7443	UPDATE	Priority	High	N/A
12/18/2024	3.33.0	RULE-7443	UPDATE	Category	Provider enrollment	N/A
12/18/2024	3.33.0	RULE-7443	UPDATE	For ta comprehensive	TA- Inferential	No
12/18/2024	3.33.0	RULE-7443	UPDATE	For ta inferential	Yes	No
12/18/2024	3.33.0	RULE-7443	UPDATE	Ta min	0
12/18/2024	3.33.0	RULE-7443	UPDATE	Ta max	0.05
12/18/2024	3.33.0	RULE-7442	UPDATE	Priority	High	N/A
12/18/2024	3.33.0	RULE-7442	UPDATE	Category	Provider enrollment	N/A
12/18/2024	3.33.0	RULE-7442	UPDATE	For ta comprehensive	TA- Inferential	No
12/18/2024	3.33.0	RULE-7442	UPDATE	For ta inferential	Yes	No
12/18/2024	3.33.0	RULE-7442	UPDATE	Ta min	0
12/18/2024	3.33.0	RULE-7442	UPDATE	Ta max	0.05
12/18/2024	3.33.0	RULE-7441	UPDATE	Priority	High	N/A
12/18/2024	3.33.0	RULE-7441	UPDATE	Category	Provider enrollment	N/A
12/18/2024	3.33.0	RULE-7441	UPDATE	For ta comprehensive	TA- Inferential	No
12/18/2024	3.33.0	RULE-7441	UPDATE	For ta inferential	Yes	No
12/18/2024	3.33.0	RULE-7441	UPDATE	Ta min	0
12/18/2024	3.33.0	RULE-7441	UPDATE	Ta max	0.05
12/18/2024	3.33.0	RULE-7440	UPDATE	Priority	High	N/A
12/18/2024	3.33.0	RULE-7440	UPDATE	Category	Provider enrollment	N/A
12/18/2024	3.33.0	RULE-7440	UPDATE	For ta comprehensive	TA- Inferential	No
12/18/2024	3.33.0	RULE-7440	UPDATE	For ta inferential	Yes	No
12/18/2024	3.33.0	RULE-7440	UPDATE	Ta min	0
12/18/2024	3.33.0	RULE-7440	UPDATE	Ta max	0.05
12/18/2024	3.33.0	RULE-7439	UPDATE	Priority	High	N/A
12/18/2024	3.33.0	RULE-7439	UPDATE	Category	Provider enrollment	N/A
12/18/2024	3.33.0	RULE-7439	UPDATE	For ta comprehensive	TA- Inferential	No
12/18/2024	3.33.0	RULE-7439	UPDATE	For ta inferential	Yes	No
12/18/2024	3.33.0	RULE-7439	UPDATE	Ta min	0
12/18/2024	3.33.0	RULE-7439	UPDATE	Ta max	0.05
02/02/2024	3.18.0	PRV-2-011-11	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month or missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider Classification Lookup Designation indicates NPI is required (non-atypical providers)Of the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that meet the following criteria:1. PROV-CLASSIFICATION-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Atypical Provider Lookup table2. 'NPI Required' is "YES"STEP 4: NPI is presentOf the records that meet the criteria from STEP 3, restrict to segments that meet the following criteria:1. PROV-IDENTIFIER-TYPE = 22. SUBMITTING-STATE-PROV-ID is not NULLSTEP 5: NPI is not presentSubtract the count of unique SUBMITTING-STATE-PROV-IDs from STEP 4 from the count from STEP 3STEP 6: Calculate percent that do not have an NPIDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 5 by the count from STEP 3	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 3: Provider Classification Lookup Designation indicates NPI is required (non-atypical providers)Of the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that meet the following criteria:1. PROV-CLASSIFICATION-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Atypical Provider Lookup table2. 'NPI Required' is "YES"STEP 4: Provider identifier is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROV-IDENTIFIER-PRV00005 by keeping records that satisfy the following criteria:1a. PROV-IDENTIFIER-EFF-DATE <= last day of the reporting month2a. PROV-IDENTIFIER-END-DATE >= last day of the reporting month OR missingOR1b. PROV-IDENTIFIER-EFF-DATE is missing2b. PROV-IDENTIFIER-END-DATE is missingSTEP 5: NPI is presentOf the records that meet the criteria from STEP 4, restrict to segments that meet the following criteria:1. PROV-IDENTIFIER-TYPE = 22. SUBMITTING-STATE-PROV-ID is not NULLSTEP 6: NPI is not presentSubtract the count of unique SUBMITTING-STATE-PROV-IDs from STEP 5 from the count from STEP 3STEP 7: Calculate percent that do not have an NPIDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 6 by the count from STEP 3
06/19/2024	3.27.0	EL-1-037-44	UPDATE	Focus area	Race/ethnicity	N/A
06/19/2024	3.27.0	EL-1-036-43	UPDATE	Focus area	Race/ethnicity	N/A
06/19/2024	3.27.0	EL-1-035-42	UPDATE	Focus area	Race/ethnicity	N/A
06/19/2024	3.27.0	EL-1-034-41	UPDATE	Focus area	Race/ethnicity	N/A
06/19/2024	3.27.0	EL-1-033-40	UPDATE	Focus area	Race/ethnicity	N/A
06/19/2024	3.27.0	EL-1-032-39	UPDATE	Focus area	Race/ethnicity	N/A
11/15/2023	3.16.0	MCR-65-012-12	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Integrated Care for Dual EligiblesOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("80")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without Integrated Care for Dual EligiblesSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Integrated Care for Dual EligiblesOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("80")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation Payment: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without Integrated Care for Dual EligiblesSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3
11/15/2023	3.16.0	MCR-65-011-11	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Health/Medical HomeOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("70")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without Health/Medical HomeSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Health/Medical HomeOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("70")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation Payment: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without Health/Medical HomeSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3
11/15/2023	3.16.0	MCR-65-010-10	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in ACOOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("60")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without ACOSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in ACOOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("60")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation Payment: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without ACOSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3
11/15/2023	3.16.0	MCR-65-009-9	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Disease ManagementOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("02", "03", or "16")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without Disease ManagementSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Disease ManagementOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("02", "03", or "16")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation Payment: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without Disease ManagementSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3
11/15/2023	3.16.0	MCR-65-008-8	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in LTSSOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("07" or "19")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without LTSSSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in LTSSOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("07" or "19")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation Payment: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without LTSSSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3
11/15/2023	3.16.0	MCR-65-007-7	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Mental Health PAHPOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("09", "11", or "13")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without Mental Health PAHPSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Mental Health PAHPOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("09", "11", or "13")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation Payment: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without Mental Health PAHPSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3
11/15/2023	3.16.0	MCR-65-006-6	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Mental Health PIHPOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("08", "10", or "12")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without Mental Health PIHPSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Mental Health PIHPOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("08", "10", or "12")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation Payment: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without Mental Health PIHPSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3
11/15/2023	3.16.0	MCR-65-005-5	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Pharmacy PAHPOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("18")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without Pharmacy PAHPSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Pharmacy PAHPOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("18")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation Payment: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without Pharmacy PAHPSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3
11/15/2023	3.16.0	MCR-65-004-4	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Dental PAHPOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("14")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without Dental PAHPSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Dental PAHPOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("14")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation Payment: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without Dental PAHPSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3
11/15/2023	3.16.0	MCR-65-003-3	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Transportation PAHPOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("15")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without Transportation PAHPSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Transportation PAHPOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("15")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation Payment: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDsSTEP 7: Count MSIS IDs without Transportation PAHPSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3
11/15/2023	3.16.0	MCR-65-002-2	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in PACE planOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("17")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDSTEP 7: Count MSIS IDs without PACE planSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in PACE planOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("17")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation Payment: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDSTEP 7: Count MSIS IDs without PACE planSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3
11/15/2023	3.16.0	MCR-65-001-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Comprehensive MCOOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("01" or "04")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDSTEP 7: Count MSIS IDs without Comprehensive MCOSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Enrollment in Comprehensive MCOOf the MSIS IDs that meet the criteria for STEP 2, further refine the population to MSIS IDs where MANAGED-CARE-PLAN-TYPE = ("01" or "04")STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid & S-CHIP Capitation Payment: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B" or "2" STEP 6: Link MSIS IDs from EL to OTRetain the MSIS IDs from STEP 3 that link to an OT claim from STEP 5 using the Plan IDSTEP 7: Count MSIS IDs without Comprehensive MCOSubtract the number of unique MSIS IDs in STEP 6 from the number of unique MSIS IDs in STEP 3STEP 8: Calculate percentageDivide the count of unique MSIS IDs in STEP 7 by the count of unique MSIS IDs in STEP 3
06/19/2024	3.27.0	EL-1-031-38	UPDATE	Priority	N/A	High
06/19/2024	3.27.0	EL-1-031-38	UPDATE	Category	N/A	Beneficiary demographics
06/19/2024	3.27.0	EL-1-031-38	UPDATE	For ta comprehensive	No	TA- Inferential
06/19/2024	3.27.0	EL-1-031-38	UPDATE	For ta inferential	No	Yes
06/19/2024	3.27.0	EL-1-031-38	UPDATE	Ta min		0
06/19/2024	3.27.0	EL-1-031-38	UPDATE	Ta max		0.2
06/19/2024	3.27.0	EL-1-031-38	UPDATE	Threshold minimum	TBD	0
06/19/2024	3.27.0	EL-1-031-38	UPDATE	Threshold maximum	TBD	0.2
06/19/2024	3.27.0	EL-1-030-37	UPDATE	Measure name	% of MSIS IDs that have a Native Hawaiian or Other Pacific Islander race (RACE = 012, 013, 014, 015, 016)	% of MSIS IDs that have Native Hawaiian or Other Pacific Islander race (RACE = 012, 013, 014, 015, 016)
06/19/2024	3.27.0	EL-1-030-37	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	EL-1-030-37	UPDATE	Threshold maximum	TBD	N/A
06/19/2024	3.27.0	EL-1-030-37	UPDATE	Annotation	Calculate the percentage of MSIS IDs with a RACE value of "012", "013", "014", "015", or "016"	N/A
06/19/2024	3.27.0	EL-1-030-37	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is Native Hawaiian or Other Pacific IslanderOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE = (“012,” “013,” “014,” “015,” or “016,”) on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.	N/A
06/19/2024	3.27.0	EL-1-030-37	UPDATE	Focus area	Race/ethnicity	N/A
06/19/2024	3.27.0	EL-1-029-36	UPDATE	Measure name	% of MSIS IDs that have an Asian race (RACE = 004, 005, 006, 007, 008, 009, 010, 011)	% of MSIS IDs that have Asian race (RACE = 004, 005, 006, 007, 008, 009, 010, 011)
06/19/2024	3.27.0	EL-1-029-36	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	EL-1-029-36	UPDATE	Threshold maximum	TBD	N/A
06/19/2024	3.27.0	EL-1-029-36	UPDATE	Annotation	Calculate the percentage of MSIS IDs with a RACE value of "004", "005", "006", "007", '008", "009", "010", or "011"	N/A
06/19/2024	3.27.0	EL-1-029-36	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is AsianOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE = (“004,” “005,” “006,” “007,” “008,” “009,” “010,” or “011,”) on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.	N/A
06/19/2024	3.27.0	EL-1-029-36	UPDATE	Focus area	Race/ethnicity	N/A
06/19/2024	3.27.0	EL-1-028-35	UPDATE	Measure name	% of MSIS IDs that have an American Indian or Alaska Native race (RACE = 003)	% of MSIS IDs that have American Indian or Alaska Native race (RACE = 003)
06/19/2024	3.27.0	EL-1-028-35	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	EL-1-028-35	UPDATE	Threshold maximum	TBD	N/A
06/19/2024	3.27.0	EL-1-028-35	UPDATE	Annotation	Calculate the percentage of MSIS IDs with a RACE value of "003"	N/A
06/19/2024	3.27.0	EL-1-028-35	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is American Indian or Alaska NativeOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE equals "003" on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.	N/A
06/19/2024	3.27.0	EL-1-028-35	UPDATE	Focus area	Race/ethnicity	N/A
06/19/2024	3.27.0	EL-1-027-34	UPDATE	Measure name	% of MSIS IDs that have a Black or African American race (RACE = 002)	% of MSIS IDs that have Black or African American race (RACE = 002)
06/19/2024	3.27.0	EL-1-027-34	UPDATE	Priority	N/A	High
06/19/2024	3.27.0	EL-1-027-34	UPDATE	Category	N/A	Beneficiary demographics
06/19/2024	3.27.0	EL-1-027-34	UPDATE	For ta comprehensive	No	TA- Inferential
06/19/2024	3.27.0	EL-1-027-34	UPDATE	For ta inferential	No	Yes
06/19/2024	3.27.0	EL-1-027-34	UPDATE	Ta min		0.01
06/19/2024	3.27.0	EL-1-027-34	UPDATE	Ta max		0.9
06/19/2024	3.27.0	EL-1-027-34	UPDATE	Threshold minimum	TBD	0.01
06/19/2024	3.27.0	EL-1-027-34	UPDATE	Threshold maximum	TBD	0.9
06/19/2024	3.27.0	EL-1-026-33	UPDATE	Measure name	% of MSIS IDs that have a White race (RACE = 001)	% of MSIS IDs that have White race (RACE = 001)
06/19/2024	3.27.0	EL-1-026-33	UPDATE	Priority	N/A	High
06/19/2024	3.27.0	EL-1-026-33	UPDATE	Category	N/A	Beneficiary demographics
06/19/2024	3.27.0	EL-1-026-33	UPDATE	For ta comprehensive	No	TA- Inferential
06/19/2024	3.27.0	EL-1-026-33	UPDATE	For ta inferential	No	Yes
06/19/2024	3.27.0	EL-1-026-33	UPDATE	Ta min		0.01
06/19/2024	3.27.0	EL-1-026-33	UPDATE	Ta max		0.9
06/19/2024	3.27.0	EL-1-026-33	UPDATE	Threshold minimum	TBD	0.01
06/19/2024	3.27.0	EL-1-026-33	UPDATE	Threshold maximum	TBD	0.9
10/07/2024	3.30.0	RULE-7646	UPDATE	Priority	Critical	High
10/07/2024	3.30.0	RULE-7645	UPDATE	Priority	Critical	High
10/07/2024	3.30.0	RULE-7644	UPDATE	Priority	Critical	High
10/07/2024	3.30.0	RULE-7643	UPDATE	Priority	Critical	High
10/07/2024	3.30.0	RULE-7642	UPDATE	Priority	Critical	High
02/02/2024	3.18.0	EL-3-019_1-34	UPDATE	Focus area	N/A	Unwinding
10/07/2024	3.30.0	RULE-7522	UPDATE	Adjustment type	All Adjustment Types	Non-void
03/27/2024	3.22.0	EL-1-025-31	UPDATE	Priority	High	N/A
03/27/2024	3.22.0	EL-1-025-31	UPDATE	Category	Beneficiary demographics	N/A
03/27/2024	3.22.0	EL-1-025-31	UPDATE	For ta comprehensive	TA- Inferential	No
03/27/2024	3.22.0	EL-1-025-31	UPDATE	For ta inferential	Yes	No
03/27/2024	3.22.0	EL-1-025-31	UPDATE	Ta min	0
03/27/2024	3.22.0	EL-1-025-31	UPDATE	Ta max	0.001
03/27/2024	3.22.0	EL-1-025-31	UPDATE	Annotation	Calculate the percentage of eligibles where any address county code or zip code is not in address state and is not missing	N/A
03/27/2024	3.22.0	EL-1-025-31	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligible contact on the last day of the DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBLE-CONTACT-INFORMATION-ELG00004 by keeping records that satisfy the following criteria:1a. ELIGIBLE-ADDR-EFF-DATE<= last day of the DQ report month2a. ELIGIBLE-ADDR-END-DATE >= last day of the DQ report month OR missingOR1b. ELIGIBLE-ADDR-EFF-DATE is missing2b. ELIGIBLE-ADDR-END-DATE is missingSTEP 3: Eligible county code or zip code does not align with eligible state and is not missingOf the records that meet the criteria from STEP 2, restrict to segments where:1a. ELIGIBILE-COUNTY-CODE is not missing2a. ELIGIBLE-COUNTY-CODE is not in ELIGIBLE-STATE OR2a. ELIGIBLE-ZIP-CODE is not missing2b. ELIGIBLE-ZIP-CODE is not in ELIGIBLE-STATESTEP 4: Calculate percentageDivide the count of unique MSIS IDs from STEP 3 by the count of unique MSIS IDs from STEP 2	N/A
02/02/2024	3.18.0	MIS-86-020-20	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-86-020-20	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	MIS-86-020-20	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-86-020-20	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-86-020-20	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-86-020-20	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-86-017-17	UPDATE	Measure name	% missing: OT-RX-CLAIM-QUANTITY-ACTUAL (CRX00003)	% missing: PRESCRIPTION-QUANTITY-ACTUAL (CRX00003)
11/15/2023	3.16.0	MIS-86-006-6	UPDATE	Measure name	% missing: DISPENSE-FEE (CRX00003)	% missing: DISPENSE-FEE-SUBMITTED (CRX00003)
11/15/2023	3.16.0	MIS-86-004-4	UPDATE	Measure name	% missing: COPAY-AMT (CRX00003)	% missing: BENEFICIARY-COPAYMENT-PAID-AMOUNT (CRX00003)
06/19/2024	3.27.0	MIS-85-027-27	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	MIS-85-027-27	UPDATE	Threshold maximum	TBD	N/A
11/15/2023	3.16.0	MIS-85-023-23	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	MIS-85-023-23	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	MIS-85-023-23	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-85-023-23	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-85-023-23	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-85-023-23	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-85-023-23	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-85-023-23	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
12/18/2024	3.33.0	MIS-85-021-21	UPDATE	Priority	Medium	High
02/02/2024	3.18.0	MIS-85-014-14	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-85-014-14	UPDATE	Category	Expenditures	N/A
02/02/2024	3.18.0	MIS-85-014-14	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-85-014-14	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-85-014-14	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-85-014-14	UPDATE	Ta max	0.02
02/02/2024	3.18.0	MIS-85-014-14	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MIS-85-005-5	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MIS-85-005-5	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MIS-85-005-5	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MIS-85-005-5	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MIS-85-005-5	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-85-005-5	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-85-005-5	UPDATE	Annotation	Character	N/A
06/19/2024	3.27.0	MIS-85-005-5	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
06/19/2024	3.27.0	MIS-85-005-5	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MIS-85-004-4	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MIS-85-004-4	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MIS-85-004-4	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MIS-85-004-4	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MIS-85-004-4	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-85-004-4	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-85-004-4	UPDATE	Annotation	Character	N/A
06/19/2024	3.27.0	MIS-85-004-4	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
06/19/2024	3.27.0	MIS-85-004-4	UPDATE	Focus area	Managed care	N/A
11/15/2023	3.16.0	MIS-85-003-3	UPDATE	Measure name	% missing: BENEFICIARY-DEDUCTIBLE-AMOUNT (CRX00002)	% missing: TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT (CRX00002)
11/15/2023	3.16.0	MIS-85-002-2	UPDATE	Measure name	% missing: BENEFICIARY-COPAYMENT-AMOUNT (CRX00002)	% missing: TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT (CRX00002)
11/15/2023	3.16.0	MIS-85-001-1	UPDATE	Measure name	% missing: BENEFICIARY-COINSURANCE-AMOUNT (CRX00002)	% missing: TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT (CRX00002)
02/02/2024	3.18.0	MIS-84-030-30	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-84-030-30	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	MIS-84-030-30	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-84-030-30	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-84-030-30	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-84-030-30	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-84-019-19	UPDATE	Measure name	% missing: OT-RX-CLAIM-QUANTITY-ACTUAL (COT00003)	% missing: SERVICE-QUANTITY-ACTUAL (COT00003)
06/19/2024	3.27.0	MIS-84-009-9	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	MIS-84-009-9	UPDATE	Threshold maximum	TBD	N/A
11/15/2023	3.16.0	MIS-84-006-6	UPDATE	Priority	High	N/A
11/15/2023	3.16.0	MIS-84-006-6	UPDATE	Category	Utilization	N/A
11/15/2023	3.16.0	MIS-84-006-6	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-84-006-6	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-84-006-6	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-84-006-6	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-84-006-6	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-84-006-6	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
11/15/2023	3.16.0	MIS-84-005-5	UPDATE	Measure name	% missing: COPAY-AMT (COT00003)	% missing: BENEFICIARY-COPAYMENT-PAID-AMOUNT (COT00003)
11/15/2023	3.16.0	MIS-84-002-2	UPDATE	Priority	High	N/A
11/15/2023	3.16.0	MIS-84-002-2	UPDATE	Category	Utilization	N/A
11/15/2023	3.16.0	MIS-84-002-2	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-84-002-2	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-84-002-2	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-84-002-2	UPDATE	Ta max	0
11/15/2023	3.16.0	MIS-84-002-2	UPDATE	Threshold maximum	0	0.02
11/15/2023	3.16.0	MIS-84-002-2	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-84-002-2	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
02/02/2024	3.18.0	MIS-83-020-20	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-83-020-20	UPDATE	Category	Expenditures	N/A
02/02/2024	3.18.0	MIS-83-020-20	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-83-020-20	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-83-020-20	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-83-020-20	UPDATE	Ta max	0.02
02/02/2024	3.18.0	MIS-83-020-20	UPDATE	Focus area	Managed care	N/A
11/15/2023	3.16.0	MIS-83-016-16	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	MIS-83-016-16	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	MIS-83-016-16	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-83-016-16	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-83-016-16	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-83-016-16	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-83-016-16	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-83-016-16	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
06/19/2024	3.27.0	MIS-83-007-7	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MIS-83-007-7	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MIS-83-007-7	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MIS-83-007-7	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MIS-83-007-7	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-83-007-7	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-83-007-7	UPDATE	Annotation	Character	N/A
06/19/2024	3.27.0	MIS-83-007-7	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
06/19/2024	3.27.0	MIS-83-007-7	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MIS-83-005-5	UPDATE	Priority	High	Medium
06/19/2024	3.27.0	MIS-83-005-5	UPDATE	Ta max	0.15	0.3
06/19/2024	3.27.0	MIS-83-005-5	UPDATE	Threshold maximum	0.15	0.3
11/15/2023	3.16.0	MIS-83-004-4	UPDATE	Measure name	% missing: BENEFICIARY-DEDUCTIBLE-AMOUNT (COT00002)	% missing: TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT (COT00002)
11/15/2023	3.16.0	MIS-83-003-3	UPDATE	Measure name	% missing: BENEFICIARY-COPAYMENT-AMOUNT (COT00002)	% missing: TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT (COT00002)
11/15/2023	3.16.0	MIS-83-002-2	UPDATE	Measure name	% missing: BENEFICIARY-COINSURANCE-AMOUNT (COT00002)	% missing: TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT (COT00002)
11/15/2023	3.16.0	MIS-83-001-1	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	MIS-83-001-1	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	MIS-83-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-83-001-1	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-83-001-1	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-83-001-1	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-83-001-1	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-83-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
02/02/2024	3.18.0	MIS-82-017-17	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-82-017-17	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	MIS-82-017-17	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-82-017-17	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-82-017-17	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-82-017-17	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-82-003-3	UPDATE	Priority	High	N/A
11/15/2023	3.16.0	MIS-82-003-3	UPDATE	Category	Utilization	N/A
11/15/2023	3.16.0	MIS-82-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-82-003-3	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-82-003-3	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-82-003-3	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-82-003-3	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-82-003-3	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
11/15/2023	3.16.0	MIS-82-002-2	UPDATE	Priority	High	N/A
11/15/2023	3.16.0	MIS-82-002-2	UPDATE	Category	Utilization	N/A
11/15/2023	3.16.0	MIS-82-002-2	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-82-002-2	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-82-002-2	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-82-002-2	UPDATE	Ta max	0
11/15/2023	3.16.0	MIS-82-002-2	UPDATE	Threshold maximum	0	0.02
11/15/2023	3.16.0	MIS-82-002-2	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-82-002-2	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	N/A
02/02/2024	3.18.0	MIS-81-026-26	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-81-026-26	UPDATE	Category	Expenditures	N/A
02/02/2024	3.18.0	MIS-81-026-26	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-81-026-26	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-81-026-26	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-81-026-26	UPDATE	Ta max	0.02
02/02/2024	3.18.0	MIS-81-026-26	UPDATE	Focus area	Managed care	N/A
11/15/2023	3.16.0	MIS-81-018-18	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	MIS-81-018-18	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	MIS-81-018-18	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-81-018-18	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-81-018-18	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-81-018-18	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-81-018-18	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-81-018-18	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),	N/A
06/19/2024	3.27.0	MIS-81-009-9	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MIS-81-009-9	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MIS-81-009-9	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MIS-81-009-9	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MIS-81-009-9	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-81-009-9	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-81-009-9	UPDATE	Annotation	Character	N/A
06/19/2024	3.27.0	MIS-81-009-9	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),	N/A
06/19/2024	3.27.0	MIS-81-009-9	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MIS-81-007-7	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MIS-81-007-7	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MIS-81-007-7	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MIS-81-007-7	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MIS-81-007-7	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-81-007-7	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-81-007-7	UPDATE	Annotation	Character	N/A
06/19/2024	3.27.0	MIS-81-007-7	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),	N/A
06/19/2024	3.27.0	MIS-81-007-7	UPDATE	Focus area	Managed care	N/A
11/15/2023	3.16.0	MIS-81-006-6	UPDATE	Measure name	% missing: BENEFICIARY-DEDUCTIBLE-AMOUNT (CLT00002)	% missing: TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT (CLT00002)
11/15/2023	3.16.0	MIS-81-005-5	UPDATE	Measure name	% missing: BENEFICIARY-COPAYMENT-AMOUNT (CLT00002)	% missing: TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT (CLT00002)
11/15/2023	3.16.0	MIS-81-004-4	UPDATE	Measure name	% missing: BENEFICIARY-COINSURANCE-AMOUNT (CLT00002)	% missing: TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT (CLT00002)
11/15/2023	3.16.0	MIS-81-003-3	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	MIS-81-003-3	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	MIS-81-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-81-003-3	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-81-003-3	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-81-003-3	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-81-003-3	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-81-003-3	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),	N/A
02/02/2024	3.18.0	MIS-80-017-17	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-80-017-17	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	MIS-80-017-17	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-80-017-17	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-80-017-17	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-80-017-17	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-80-003-3	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	MIS-80-003-3	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	MIS-80-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-80-003-3	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-80-003-3	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-80-003-3	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-80-003-3	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-80-003-3	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).	N/A
11/15/2023	3.16.0	MIS-80-002-2	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	MIS-80-002-2	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	MIS-80-002-2	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-80-002-2	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-80-002-2	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-80-002-2	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-80-002-2	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-80-002-2	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).	N/A
06/19/2024	3.27.0	MIS-79-055-55	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	MIS-79-055-55	UPDATE	Threshold maximum	TBD	N/A
02/02/2024	3.18.0	MIS-79-033-33	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-79-033-33	UPDATE	Category	Expenditures	N/A
02/02/2024	3.18.0	MIS-79-033-33	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-79-033-33	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-79-033-33	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-79-033-33	UPDATE	Ta max	0.02
02/02/2024	3.18.0	MIS-79-033-33	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MIS-79-010-10	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MIS-79-010-10	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MIS-79-010-10	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MIS-79-010-10	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MIS-79-010-10	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-79-010-10	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-79-010-10	UPDATE	Annotation	Character	N/A
06/19/2024	3.27.0	MIS-79-010-10	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
06/19/2024	3.27.0	MIS-79-010-10	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MIS-79-008-8	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MIS-79-008-8	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MIS-79-008-8	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MIS-79-008-8	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MIS-79-008-8	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-79-008-8	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-79-008-8	UPDATE	Annotation	Character	N/A
06/19/2024	3.27.0	MIS-79-008-8	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
06/19/2024	3.27.0	MIS-79-008-8	UPDATE	Focus area	Managed care	N/A
11/15/2023	3.16.0	MIS-79-007-7	UPDATE	Measure name	% missing: BENEFICIARY-DEDUCTIBLE-AMOUNT (CIP00002)	% missing: TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT (CIP00002)
11/15/2023	3.16.0	MIS-79-006-6	UPDATE	Measure name	% missing: BENEFICIARY-COPAYMENT-AMOUNT (CIP00002)	% missing: TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT (CIP00002)
11/15/2023	3.16.0	MIS-79-005-5	UPDATE	Measure name	% missing: BENEFICIARY-COINSURANCE-AMOUNT (CIP00002)	% missing: TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT (CIP00002)
11/15/2023	3.16.0	MIS-79-001-1	UPDATE	Priority	High	N/A
11/15/2023	3.16.0	MIS-79-001-1	UPDATE	Category	Utilization	N/A
11/15/2023	3.16.0	MIS-79-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-79-001-1	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-79-001-1	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-79-001-1	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-79-001-1	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-79-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)	N/A
02/02/2024	3.18.0	MIS-28-021-21	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-28-021-21	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	MIS-28-021-21	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-28-021-21	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-28-021-21	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-28-021-21	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-28-018-18	UPDATE	Measure name	% missing: OT-RX-CLAIM-QUANTITY-ACTUAL (CRX00003)	% missing: PRESCRIPTION-QUANTITY-ACTUAL (CRX00003)
11/15/2023	3.16.0	MIS-28-007-7	UPDATE	Measure name	% missing: DISPENSE-FEE (CRX00003)	% missing: DISPENSE-FEE-SUBMITTED (CRX00003)
11/15/2023	3.16.0	MIS-28-005-5	UPDATE	Measure name	% missing: COPAY-AMT (CRX00003)	% missing: BENEFICIARY-COPAYMENT-PAID-AMOUNT (CRX00003)
06/19/2024	3.27.0	MIS-28-003-3	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-28-003-3	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-28-003-3	UPDATE	Threshold minimum	N/A	0
06/19/2024	3.27.0	MIS-28-003-3	UPDATE	Threshold maximum	N/A	0.02
06/19/2024	3.27.0	MIS-27-027-27	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	MIS-27-027-27	UPDATE	Threshold maximum	TBD	N/A
11/15/2023	3.16.0	MIS-27-023-23	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	MIS-27-023-23	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	MIS-27-023-23	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-27-023-23	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-27-023-23	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-27-023-23	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-27-023-23	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-27-023-23	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
12/18/2024	3.33.0	MIS-27-021-21	UPDATE	Priority	Medium	High
02/02/2024	3.18.0	MIS-27-014-14	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-27-014-14	UPDATE	Category	Expenditures	N/A
02/02/2024	3.18.0	MIS-27-014-14	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-27-014-14	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-27-014-14	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-27-014-14	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-27-005-5	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MIS-27-005-5	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MIS-27-005-5	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MIS-27-005-5	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MIS-27-005-5	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-27-005-5	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-27-005-5	UPDATE	Annotation	Character	N/A
06/19/2024	3.27.0	MIS-27-005-5	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
06/19/2024	3.27.0	MIS-27-004-4	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MIS-27-004-4	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MIS-27-004-4	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MIS-27-004-4	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MIS-27-004-4	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-27-004-4	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-27-004-4	UPDATE	Annotation	Character	N/A
06/19/2024	3.27.0	MIS-27-004-4	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/15/2023	3.16.0	MIS-27-003-3	UPDATE	Measure name	% missing: BENEFICIARY-DEDUCTIBLE-AMOUNT (CRX00002)	% missing: TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT (CRX00002)
11/15/2023	3.16.0	MIS-27-002-2	UPDATE	Measure name	% missing: BENEFICIARY-COPAYMENT-AMOUNT (CRX00002)	% missing: TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT (CRX00002)
11/15/2023	3.16.0	MIS-27-001-1	UPDATE	Measure name	% missing: BENEFICIARY-COINSURANCE-AMOUNT (CRX00002)	% missing: TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT (CRX00002)
02/02/2024	3.18.0	MIS-26-031-31	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-26-031-31	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	MIS-26-031-31	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-26-031-31	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-26-031-31	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-26-031-31	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-26-007-7	UPDATE	Priority	High	N/A
11/15/2023	3.16.0	MIS-26-007-7	UPDATE	Category	Utilization	N/A
11/15/2023	3.16.0	MIS-26-007-7	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-26-007-7	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-26-007-7	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-26-007-7	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-26-007-7	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-26-007-7	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/15/2023	3.16.0	MIS-26-006-6	UPDATE	Measure name	% missing: COPAY-AMT (COT00003)	% missing: BENEFICIARY-COPAYMENT-PAID-AMOUNT (COT00003)
06/19/2024	3.27.0	MIS-26-005-5	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-26-005-5	UPDATE	Ta max	0.1
06/19/2024	3.27.0	MIS-26-005-5	UPDATE	Threshold minimum	N/A	0
06/19/2024	3.27.0	MIS-26-005-5	UPDATE	Threshold maximum	N/A	0.1
11/15/2023	3.16.0	MIS-26-003-3	UPDATE	Priority	High	N/A
11/15/2023	3.16.0	MIS-26-003-3	UPDATE	Category	Utilization	N/A
11/15/2023	3.16.0	MIS-26-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-26-003-3	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-26-003-3	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-26-003-3	UPDATE	Ta max	0
11/15/2023	3.16.0	MIS-26-003-3	UPDATE	Threshold maximum	0	0.02
11/15/2023	3.16.0	MIS-26-003-3	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-26-003-3	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/15/2023	3.16.0	MIS-26-002-20	UPDATE	Measure name	% missing: OT-RX-CLAIM-QUANTITY-ACTUAL (COT00003)	% missing: SERVICE-QUANTITY-ACTUAL (COT00003)
06/19/2024	3.27.0	MIS-26-001-10	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	MIS-26-001-10	UPDATE	Threshold maximum	TBD	N/A
11/15/2023	3.16.0	MIS-25-016-16	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	MIS-25-016-16	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	MIS-25-016-16	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-25-016-16	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-25-016-16	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-25-016-16	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-25-016-16	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-25-016-16	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
06/19/2024	3.27.0	MIS-25-007-7	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MIS-25-007-7	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MIS-25-007-7	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MIS-25-007-7	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MIS-25-007-7	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-25-007-7	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-25-007-7	UPDATE	Annotation	Character	N/A
06/19/2024	3.27.0	MIS-25-007-7	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
06/19/2024	3.27.0	MIS-25-005-5	UPDATE	Priority	High	Medium
06/19/2024	3.27.0	MIS-25-005-5	UPDATE	Ta max	0.15	0.3
06/19/2024	3.27.0	MIS-25-005-5	UPDATE	Threshold maximum	0.15	0.3
11/15/2023	3.16.0	MIS-25-004-4	UPDATE	Measure name	% missing: BENEFICIARY-DEDUCTIBLE-AMOUNT (COT00002)	% missing: TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT (COT00002)
11/15/2023	3.16.0	MIS-25-003-3	UPDATE	Measure name	% missing: BENEFICIARY-COPAYMENT-AMOUNT (COT00002)	% missing: TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT (COT00002)
02/02/2024	3.18.0	MIS-25-002-20	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-25-002-20	UPDATE	Category	Expenditures	N/A
02/02/2024	3.18.0	MIS-25-002-20	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-25-002-20	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-25-002-20	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-25-002-20	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-25-002-2	UPDATE	Measure name	% missing: BENEFICIARY-COINSURANCE-AMOUNT (COT00002)	% missing: TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT (COT00002)
11/15/2023	3.16.0	MIS-25-001-1	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	MIS-25-001-1	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	MIS-25-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-25-001-1	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-25-001-1	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-25-001-1	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-25-001-1	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-25-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
02/02/2024	3.18.0	MIS-24-018-18	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-24-018-18	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	MIS-24-018-18	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-24-018-18	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-24-018-18	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-24-018-18	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-24-012-12	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-24-012-12	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-24-012-12	UPDATE	Threshold minimum	N/A	0
06/19/2024	3.27.0	MIS-24-012-12	UPDATE	Threshold maximum	N/A	0.02
11/15/2023	3.16.0	MIS-24-004-4	UPDATE	Priority	High	N/A
11/15/2023	3.16.0	MIS-24-004-4	UPDATE	Category	Utilization	N/A
11/15/2023	3.16.0	MIS-24-004-4	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-24-004-4	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-24-004-4	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-24-004-4	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-24-004-4	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-24-004-4	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/15/2023	3.16.0	MIS-24-003-3	UPDATE	Priority	High	N/A
11/15/2023	3.16.0	MIS-24-003-3	UPDATE	Category	Utilization	N/A
11/15/2023	3.16.0	MIS-24-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-24-003-3	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-24-003-3	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-24-003-3	UPDATE	Ta max	0
11/15/2023	3.16.0	MIS-24-003-3	UPDATE	Threshold maximum	0	0.02
11/15/2023	3.16.0	MIS-24-003-3	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-24-003-3	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
02/02/2024	3.18.0	MIS-23-026-26	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-23-026-26	UPDATE	Category	Expenditures	N/A
02/02/2024	3.18.0	MIS-23-026-26	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-23-026-26	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-23-026-26	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-23-026-26	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-23-018-18	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	MIS-23-018-18	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	MIS-23-018-18	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-23-018-18	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-23-018-18	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-23-018-18	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-23-018-18	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-23-018-18	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS or Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
06/19/2024	3.27.0	MIS-23-009-9	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MIS-23-009-9	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MIS-23-009-9	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MIS-23-009-9	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MIS-23-009-9	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-23-009-9	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-23-009-9	UPDATE	Annotation	Character	N/A
06/19/2024	3.27.0	MIS-23-009-9	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS or Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
06/19/2024	3.27.0	MIS-23-007-7	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MIS-23-007-7	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MIS-23-007-7	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MIS-23-007-7	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MIS-23-007-7	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-23-007-7	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-23-007-7	UPDATE	Annotation	Character	N/A
06/19/2024	3.27.0	MIS-23-007-7	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS or Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/15/2023	3.16.0	MIS-23-006-6	UPDATE	Measure name	% missing: BENEFICIARY-DEDUCTIBLE-AMOUNT (CLT00002)	% missing: TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT (CLT00002)
11/15/2023	3.16.0	MIS-23-005-5	UPDATE	Measure name	% missing: BENEFICIARY-COPAYMENT-AMOUNT (CLT00002)	% missing: TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT (CLT00002)
11/15/2023	3.16.0	MIS-23-004-4	UPDATE	Measure name	% missing: BENEFICIARY-COINSURANCE-AMOUNT (CLT00002)	% missing: TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT (CLT00002)
11/15/2023	3.16.0	MIS-23-003-3	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	MIS-23-003-3	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	MIS-23-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-23-003-3	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-23-003-3	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-23-003-3	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-23-003-3	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-23-003-3	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS or Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
02/02/2024	3.18.0	MIS-22-018-18	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-22-018-18	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	MIS-22-018-18	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-22-018-18	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-22-018-18	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-22-018-18	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-22-012-12	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-22-012-12	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-22-012-12	UPDATE	Threshold minimum	N/A	0
06/19/2024	3.27.0	MIS-22-012-12	UPDATE	Threshold maximum	N/A	0.02
11/15/2023	3.16.0	MIS-22-004-4	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	MIS-22-004-4	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	MIS-22-004-4	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-22-004-4	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-22-004-4	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-22-004-4	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-22-004-4	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-22-004-4	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/15/2023	3.16.0	MIS-22-003-3	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	MIS-22-003-3	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	MIS-22-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-22-003-3	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-22-003-3	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-22-003-3	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-22-003-3	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-22-003-3	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
06/19/2024	3.27.0	MIS-21-055-55	UPDATE	Threshold minimum	TBD	N/A
06/19/2024	3.27.0	MIS-21-055-55	UPDATE	Threshold maximum	TBD	N/A
02/02/2024	3.18.0	MIS-21-033-33	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-21-033-33	UPDATE	Category	Expenditures	N/A
02/02/2024	3.18.0	MIS-21-033-33	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-21-033-33	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-21-033-33	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-21-033-33	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-21-010-10	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MIS-21-010-10	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MIS-21-010-10	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MIS-21-010-10	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MIS-21-010-10	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-21-010-10	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-21-010-10	UPDATE	Annotation	Character	N/A
06/19/2024	3.27.0	MIS-21-010-10	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
06/19/2024	3.27.0	MIS-21-008-8	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MIS-21-008-8	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MIS-21-008-8	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MIS-21-008-8	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MIS-21-008-8	UPDATE	Ta min	0
06/19/2024	3.27.0	MIS-21-008-8	UPDATE	Ta max	0.02
06/19/2024	3.27.0	MIS-21-008-8	UPDATE	Annotation	Character	N/A
06/19/2024	3.27.0	MIS-21-008-8	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/15/2023	3.16.0	MIS-21-007-7	UPDATE	Measure name	% missing: BENEFICIARY-DEDUCTIBLE-AMOUNT (CIP00002)	% missing: TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT (CIP00002)
11/15/2023	3.16.0	MIS-21-006-6	UPDATE	Measure name	% missing: BENEFICIARY-COPAYMENT-AMOUNT (CIP00002)	% missing: TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT (CIP00002)
11/15/2023	3.16.0	MIS-21-005-5	UPDATE	Measure name	% missing: BENEFICIARY-COINSURANCE-AMOUNT (CIP00002)	% missing: TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT (CIP00002)
11/15/2023	3.16.0	MIS-21-001-1	UPDATE	Priority	High	N/A
11/15/2023	3.16.0	MIS-21-001-1	UPDATE	Category	Utilization	N/A
11/15/2023	3.16.0	MIS-21-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-21-001-1	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-21-001-1	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-21-001-1	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-21-001-1	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-21-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
10/07/2024	3.30.0	RULE-7536	UPDATE	Adjustment type	Original and Replacement	Non-void
10/07/2024	3.30.0	RULE-7535	UPDATE	Adjustment type	Original and Replacement	Non-void
10/07/2024	3.30.0	RULE-7533	UPDATE	Adjustment type	Original and Replacement	Non-void
03/27/2024	3.22.0	RULE-7379	UPDATE	Measure name	% of non-zero paid claim lines with Title XXI funding with missing XXI-MBESCBES-CATEGORY-OF-SERVICE (CRX00003)	% of claim lines on non-zero paid claims with Title XXI funding with missing XXI-MBESCBES-CATEGORY-OF-SERVICE (CRX00003)
03/27/2024	3.22.0	RULE-7378	UPDATE	Measure name	% of non-zero paid claim lines with Title XXI funding with missing XXI-MBESCBES-CATEGORY-OF-SERVICE (COT00003)	% of claim lines on non-zero paid claims with Title XXI funding with missing XXI-MBESCBES-CATEGORY-OF-SERVICE (COT00003)
03/27/2024	3.22.0	RULE-7377	UPDATE	Measure name	% of non-zero paid claim lines with Title XXI funding with missing XXI-MBESCBES-CATEGORY-OF-SERVICE (CLT00003)	% of claim lines on non-zero paid claims with Title XXI funding with missing XXI-MBESCBES-CATEGORY-OF-SERVICE (CLT00003)
03/27/2024	3.22.0	RULE-7376	UPDATE	Measure name	% of non-zero paid claim lines with Title XXI funding with missing XXI-MBESCBES-CATEGORY-OF-SERVICE (CIP00003)	% of claim lines on non-zero paid claims with Title XXI funding with missing XXI-MBESCBES-CATEGORY-OF-SERVICE (CIP00003)
03/27/2024	3.22.0	RULE-7375	UPDATE	Measure name	% of non-zero paid claim lines with Title XIX funding with missing XIX-MBESCBES-CATEGORY-OF-SERVICE (CRX00003)	% of claim lines on non-zero paid claims with Title XIX funding with missing XIX-MBESCBES-CATEGORY-OF-SERVICE (CRX00003)
03/27/2024	3.22.0	RULE-7374	UPDATE	Measure name	% of non-zero paid claim lines with Title XIX funding with missing XIX-MBESCBES-CATEGORY-OF-SERVICE (COT00003)	% of claim lines on non-zero paid claims with Title XIX funding with missing XIX-MBESCBES-CATEGORY-OF-SERVICE (COT00003)
03/27/2024	3.22.0	RULE-7373	UPDATE	Measure name	% of non-zero paid claim lines with Title XIX funding with missing XIX-MBESCBES-CATEGORY-OF-SERVICE (CLT00003)	% of claim lines on non-zero paid claims with Title XIX funding with missing XIX-MBESCBES-CATEGORY-OF-SERVICE (CLT00003)
03/27/2024	3.22.0	RULE-7372	UPDATE	Measure name	% of non-zero paid claim lines with Title XIX funding with missing XIX-MBESCBES-CATEGORY-OF-SERVICE (CIP00003)	% of claim lines on non-zero paid claims with Title XIX funding with missing XIX-MBESCBES-CATEGORY-OF-SERVICE (CIP00003)
06/19/2024	3.27.0	PRV-6-004-4	UPDATE	Annotation	Calculate the percentage of submitting state provider IDs that have a facility group individual code indicating individual that are missing provider classification code	N/A
06/19/2024	3.27.0	PRV-6-004-4	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is an individualOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "03"STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Code is missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population using segment by keeping records that meet the following criteria:1. PROVIDER-CLASSIFICATION-CODE is always missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3	N/A
06/19/2024	3.27.0	PRV-6-003-3	UPDATE	Annotation	Calculate the percentage of submitting state provider IDs that have a facility group individual code indicating facility or group that are missing provider classification code	N/A
06/19/2024	3.27.0	PRV-6-003-3	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month or missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is a facility or groupOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "01" or "02"STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Code is missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1. PROVIDER-CLASSIFICATION-CODE is always missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3	N/A
06/19/2024	3.27.0	PRV-6-002-2	UPDATE	Priority	N/A	Medium
06/19/2024	3.27.0	PRV-6-002-2	UPDATE	Category	N/A	Provider identifiers
06/19/2024	3.27.0	PRV-6-002-2	UPDATE	For ta comprehensive	No	TA- Inferential
06/19/2024	3.27.0	PRV-6-002-2	UPDATE	For ta inferential	No	Yes
06/19/2024	3.27.0	PRV-6-002-2	UPDATE	Ta min		0
06/19/2024	3.27.0	PRV-6-002-2	UPDATE	Ta max		0.1
06/19/2024	3.27.0	PRV-6-001-1	UPDATE	Priority	N/A	Medium
06/19/2024	3.27.0	PRV-6-001-1	UPDATE	Category	N/A	Provider identifiers
06/19/2024	3.27.0	PRV-6-001-1	UPDATE	For ta comprehensive	No	TA- Inferential
06/19/2024	3.27.0	PRV-6-001-1	UPDATE	For ta inferential	No	Yes
06/19/2024	3.27.0	PRV-6-001-1	UPDATE	Ta min		0
06/19/2024	3.27.0	PRV-6-001-1	UPDATE	Ta max		0.2
06/19/2024	3.27.0	PRV-6-001-1	UPDATE	Threshold maximum	0.1	0.2
11/15/2023	3.16.0	FFS-49-004-16	UPDATE	Priority	High	N/A
11/15/2023	3.16.0	FFS-49-004-16	UPDATE	Category	Expenditures	N/A
11/15/2023	3.16.0	FFS-49-004-16	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	FFS-49-004-16	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	FFS-49-004-16	UPDATE	Ta min	0
11/15/2023	3.16.0	FFS-49-004-16	UPDATE	Ta max	0.01
11/15/2023	3.16.0	FFS-49-004-16	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: original, paid RX claims that are paid at the line level where the sum of Medicaid paid amount from the lines does not equal total Medicaid paid amount from the header	N/A
11/15/2023	3.16.0	FFS-49-004-16	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Exclude childless headersOf the claim headers that meet the criteria from STEP 2, drop all headers that do not merge to at least one lineSTEP 4: Claims paid at the line levelOf claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 4, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 6: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 5 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 7: Calculate the percentage for the measureDivide the count of header claims from STEP 6 by the count of header claims from STEP 4	N/A
11/15/2023	3.16.0	FFS-49-003-15	UPDATE	Priority	High	N/A
11/15/2023	3.16.0	FFS-49-003-15	UPDATE	Category	Expenditures	N/A
11/15/2023	3.16.0	FFS-49-003-15	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	FFS-49-003-15	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	FFS-49-003-15	UPDATE	Ta min	0
11/15/2023	3.16.0	FFS-49-003-15	UPDATE	Ta max	0.01
11/15/2023	3.16.0	FFS-49-003-15	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS : original, paid OT claims that are paid at the line level where the sum of Medicaid paid amount from the lines does not equal total Medicaid paid amount from the header	N/A
11/15/2023	3.16.0	FFS-49-003-15	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Exclude childless headersOf the claim headers that meet the criteria from STEP 2, drop all headers that do not merge to at least one lineSTEP 4: Claims paid at the line levelOf claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 4, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 6: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 5 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 7: Calculate the percentage for the measureDivide the count of header claims from STEP 6 by the count of header claims from STEP 4	N/A
11/15/2023	3.16.0	FFS-49-002-14	UPDATE	Priority	High	N/A
11/15/2023	3.16.0	FFS-49-002-14	UPDATE	Category	Expenditures	N/A
11/15/2023	3.16.0	FFS-49-002-14	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	FFS-49-002-14	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	FFS-49-002-14	UPDATE	Ta min	0
11/15/2023	3.16.0	FFS-49-002-14	UPDATE	Ta max	0.01
11/15/2023	3.16.0	FFS-49-002-14	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: original, paid LT claims that are paid at the line level where the sum of Medicaid paid amount from the lines does not equal total Medicaid paid amount from the header	N/A
11/15/2023	3.16.0	FFS-49-002-14	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Exclude childless headersOf the claim headers that meet the criteria from STEP 2, drop all headers that do not merge to at least one lineSTEP 4: Claims paid at the line levelOf claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 4, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 6: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 5 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 7: Calculate the percentage for the measureDivide the count of header claims from STEP 6 by the count of header claims from STEP 4	N/A
11/15/2023	3.16.0	FFS-49-001-13	UPDATE	Priority	High	N/A
11/15/2023	3.16.0	FFS-49-001-13	UPDATE	Category	Expenditures	N/A
11/15/2023	3.16.0	FFS-49-001-13	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	FFS-49-001-13	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	FFS-49-001-13	UPDATE	Ta min	0
11/15/2023	3.16.0	FFS-49-001-13	UPDATE	Ta max	0.01
11/15/2023	3.16.0	FFS-49-001-13	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: original, paid IP claims that are paid at the line level where the sum of Medicaid paid amount from the lines does not equal total Medicaid paid amount from the header	N/A
11/15/2023	3.16.0	FFS-49-001-13	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Exclude childless headersOf the claim headers that meet the criteria from STEP 2, drop all headers that do not merge to at least one lineSTEP 4: Claims paid at the line levelOf claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 4, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 6: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 5 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 7: Calculate the percentage for the measureDivide the count of header claims from STEP 6 by the count of header claims from STEP 4	N/A
03/27/2024	3.22.0	ALL-35-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Tooth-related procedure codesOf the claims that meet criteria from STEP 2, keep those with a PROCEDURE-CODE that matches one of the following criteria:1. PROCEDURE-CODE = “D1351” or “D2140” or “D2150” or “D2160” or “D2161” or “D2331” or “D2332” or “D2335” or “D2390” or “D2391” or “D2392” or “D2393” or “D2394” or “D3230” or “D3240” or “D3310” or “D3320” or “D3330”STEP 4: Missing tooth numberOf the claims that meet criteria from STEP 3, keep those with a missing TOOTH-NUMSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Tooth-related procedure codesOf the claims that meet criteria from STEP 2, keep those with a PROCEDURE-CODE that matches one of the following criteria:1. PROCEDURE-CODE = “D1351” or “D2140” or “D2150” or “D2160” or “D2161” or “D2330” or “D2331” or “D2332” or “D2335” or “D2390” or “D2391” or “D2392” or “D2393” or “D2394” or “D3230” or “D3240” or “D3310” or “D3320” or “D3330”STEP 4: Missing tooth numberOf the claims that meet criteria from STEP 3, keep those with a missing TOOTH-NUMSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3
03/27/2024	3.22.0	ALL-35-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Tooth-related procedure codesOf the claims that meet criteria from STEP 2, keep those with a PROCEDURE-CODE that matches one of the following criteria:1. PROCEDURE-CODE = “D1351” or “D2140” or “D2150” or “D2160” or “D2161” or “D2331” or “D2332” or “D2335” or “D2390” or “D2391” or “D2392” or “D2393” or “D2394” or “D3230” or “D3240” or “D3310” or “D3320” or “D3330”STEP 4: Missing tooth numberOf the claims that meet criteria from STEP 3, keep those with a missing TOOTH-NUMSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS and Encounter: Original and Replacement Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Tooth-related procedure codesOf the claims that meet criteria from STEP 2, keep those with a PROCEDURE-CODE that matches one of the following criteria:1. PROCEDURE-CODE = “D1351” or “D2140” or “D2150” or “D2160” or “D2161” or “D2330” or “D2331” or “D2332” or “D2335” or “D2390” or “D2391” or “D2392” or “D2393” or “D2394” or “D3230” or “D3240” or “D3310” or “D3320” or “D3330”STEP 4: Missing tooth numberOf the claims that meet criteria from STEP 3, keep those with a missing TOOTH-NUMSTEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 3
02/02/2024	3.18.0	RULE-7447	UPDATE	Focus area	N/A	Unwinding
06/19/2024	3.27.0	ALL-27-002-2	UPDATE	Longitudinal threshold	TBD	N/A
06/19/2024	3.27.0	ALL-27-001-1	UPDATE	Longitudinal threshold	TBD	N/A
02/26/2025	3.34.0	RULE-2810	UPDATE	For ta comprehensive	TA- Inferential	No
02/26/2025	3.34.0	RULE-2810	UPDATE	For ta inferential	Yes	No
03/27/2024	3.22.0	RULE-2157	UPDATE	Measure name	Ratio of errors for RULE-2157 in single reporting period	% of MSIS IDs with an alien restricted benefits code status (RESTRICTED-BENEFITS-CODE = 2) but CITIZENSHIP-IND = 1
03/27/2024	3.22.0	RULE-2157	UPDATE	Measure type	Ratio	Non-Claims Percentage
03/27/2024	3.22.0	RULE-2157	UPDATE	Active	False	True
03/27/2024	3.22.0	RULE-2157	UPDATE	Priority	N/A	High
03/27/2024	3.22.0	RULE-2157	UPDATE	Category	N/A	Beneficiary demographics
03/27/2024	3.22.0	RULE-2157	UPDATE	For ta comprehensive	No	TA- Inferential
03/27/2024	3.22.0	RULE-2157	UPDATE	For ta inferential	No	Yes
03/27/2024	3.22.0	RULE-2157	UPDATE	Ta min		0
03/27/2024	3.22.0	RULE-2157	UPDATE	Ta max		0.01
03/27/2024	3.22.0	RULE-2157	UPDATE	Threshold minimum	N/A	0
03/27/2024	3.22.0	RULE-2157	UPDATE	Threshold maximum	N/A	0.01
02/02/2024	3.18.0	RULE-2135	UPDATE	Focus area	N/A	Unwinding
11/15/2023	3.16.0	MIS-60-002-2	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-60-002-2	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Service Tracking, Non-void claimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "4" or "D"2. ADJUSTMENT-IND does not equal "1"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/15/2023	3.16.0	MIS-60-001-1	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-60-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Service Tracking, Non-void claimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "4" or "D"2. ADJUSTMENT-IND does not equal "1"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/15/2023	3.16.0	MIS-59-002-2	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-59-002-2	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Service Tracking, Non-void claimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "4" or "D"2. ADJUSTMENT-IND does not equal "1"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/15/2023	3.16.0	MIS-59-001-1	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-59-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Service Tracking, Non-void claimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "4" or "D"2. ADJUSTMENT-IND does not equal "1"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/15/2023	3.16.0	MIS-58-002-2	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-58-002-2	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Service Tracking, Non-void claimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "4" or "D"2. ADJUSTMENT-IND does not equal "1"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/15/2023	3.16.0	MIS-58-001-1	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-58-001-1	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Service Tracking, Non-void claimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "4" or "D"2. ADJUSTMENT-IND does not equal "1"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/15/2023	3.16.0	MIS-57-002-2	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-57-002-2	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Service Tracking, Non-void claimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "4" or "D"2. ADJUSTMENT-IND does not equal "1"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/15/2023	3.16.0	MIS-57-001-1	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-57-001-1	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Service Tracking, Non-void claimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "4" or "D"2. ADJUSTMENT-IND does not equal "1"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/15/2023	3.16.0	MIS-55-001-1	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-55-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Service Tracking, Non-void claimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "4" or "D"2. ADJUSTMENT-IND does not equal "1"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements:1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claim from STEP 2	N/A
02/02/2024	3.18.0	MCR-64-004-4	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MCR-64-003-3	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MCR-64-002-2	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MCR-64-001-1	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MCR-63-004-4	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MCR-63-003-3	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MCR-63-002-2	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	MCR-63-001-1	UPDATE	Focus area	Managed care	N/A
03/27/2024	3.22.0	EL-6-034-34	UPDATE	Priority	High	N/A
03/27/2024	3.22.0	EL-6-034-34	UPDATE	Category	Beneficiary demographics	N/A
03/27/2024	3.22.0	EL-6-034-34	UPDATE	For ta comprehensive	TA- Inferential	No
03/27/2024	3.22.0	EL-6-034-34	UPDATE	For ta inferential	Yes	No
03/27/2024	3.22.0	EL-6-034-34	UPDATE	Ta min	0
03/27/2024	3.22.0	EL-6-034-34	UPDATE	Ta max	0.01
03/27/2024	3.22.0	EL-6-034-34	UPDATE	Annotation	Calculate the percentage of eligibles with an alien restricted benefits code who have a U.S. citizenship indicator	N/A
03/27/2024	3.22.0	EL-6-034-34	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Alien restricted benefits codeOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. RESTRICTED-BENEFITS-CODE equals “2” STEP 4: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: Citizenship status indicates a U.S. CitizenOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1. CITIZENSHIP-IND equals "1"STEP 6: Calculate percentageDivide the count from STEP 5 by the count from STEP 3	N/A
03/27/2024	3.22.0	EL-6-033-33	UPDATE	Priority	High	N/A
03/27/2024	3.22.0	EL-6-033-33	UPDATE	Category	Beneficiary demographics	N/A
03/27/2024	3.22.0	EL-6-033-33	UPDATE	For ta comprehensive	TA- Inferential	No
03/27/2024	3.22.0	EL-6-033-33	UPDATE	For ta inferential	Yes	No
03/27/2024	3.22.0	EL-6-033-33	UPDATE	Ta min	0
03/27/2024	3.22.0	EL-6-033-33	UPDATE	Ta max	0.01
03/27/2024	3.22.0	EL-6-033-33	UPDATE	Annotation	Calculate the percentage of eligibles with a restricted benefits code status designating alien status whose immigration is not a qualified alien status	N/A
03/27/2024	3.22.0	EL-6-033-33	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Alien restricted benefits codeOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. RESTRICTED-BENEFITS-CODE equals “2” STEP 4: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: Immigration status is not a qualified alien statusOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1. IMMIGRATION-STATUS does not equal "1" or "2" or "3"STEP 6: Calculate percentageDivide the count from STEP 5 by the count from STEP 3	N/A
03/27/2024	3.22.0	EL-1-015_2-26	UPDATE	Priority	High	N/A
03/27/2024	3.22.0	EL-1-015_2-26	UPDATE	Category	Beneficiary demographics	N/A
03/27/2024	3.22.0	EL-1-015_2-26	UPDATE	For ta comprehensive	TA- Inferential	No
03/27/2024	3.22.0	EL-1-015_2-26	UPDATE	For ta inferential	Yes	No
03/27/2024	3.22.0	EL-1-015_2-26	UPDATE	Ta min	0
03/27/2024	3.22.0	EL-1-015_2-26	UPDATE	Ta max	0.01
03/27/2024	3.22.0	EL-1-015_2-26	UPDATE	Annotation	Calculate the percentage of eligibles with a U.S. citizenship indicator whose immigration status does not correspond to a citizen	N/A
03/27/2024	3.22.0	EL-1-015_2-26	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: U.S. citizenOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. CITIZENSHIP-IND = "1"STEP 4: Non U.S. citizen immigration statusOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. IMMIGRATION-STATUS does not equal "8"OR2. IMMIGRATION-STATUS is missingSTEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	N/A
03/27/2024	3.22.0	EL-1-015_1-25	UPDATE	Priority	High	N/A
03/27/2024	3.22.0	EL-1-015_1-25	UPDATE	Category	Beneficiary demographics	N/A
03/27/2024	3.22.0	EL-1-015_1-25	UPDATE	For ta comprehensive	TA- Inferential	No
03/27/2024	3.22.0	EL-1-015_1-25	UPDATE	For ta inferential	Yes	No
03/27/2024	3.22.0	EL-1-015_1-25	UPDATE	Ta min	0
03/27/2024	3.22.0	EL-1-015_1-25	UPDATE	Ta max	0.01
03/27/2024	3.22.0	EL-1-015_1-25	UPDATE	Annotation	Calculate the percentage of eligibles with a citizen immigration status whose citizenship indicator does not indicate they are citizens	N/A
03/27/2024	3.22.0	EL-1-015_1-25	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: U.S. citizen immigration statusOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. IMMIGRATION-STATUS = "8"STEP 4: Citizenship indicator not US CitizenOf the MSIS IDs that meet the criteria from STEP 3, restrict to those where:1. CITIZENSHIP-IND does not equal "1"OR2. CITIZENSHIP-IND is missingSTEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	N/A
02/02/2024	3.18.0	ALL-15-006-6	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	ALL-15-006-6	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	ALL-15-006-6	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	ALL-15-006-6	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	ALL-15-006-6	UPDATE	Ta min	0
02/02/2024	3.18.0	ALL-15-006-6	UPDATE	Ta max	0.01
02/02/2024	3.18.0	ALL-15-005-5	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	ALL-15-005-5	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	ALL-15-005-5	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	ALL-15-005-5	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	ALL-15-005-5	UPDATE	Ta min	0
02/02/2024	3.18.0	ALL-15-005-5	UPDATE	Ta max	0.001
02/02/2024	3.18.0	ALL-15-004-4	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	ALL-15-004-4	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	ALL-15-004-4	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	ALL-15-004-4	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	ALL-15-004-4	UPDATE	Ta min	0
02/02/2024	3.18.0	ALL-15-004-4	UPDATE	Ta max	0.001
02/02/2024	3.18.0	ALL-15-003-3	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	ALL-15-003-3	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	ALL-15-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	ALL-15-003-3	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	ALL-15-003-3	UPDATE	Ta min	0
02/02/2024	3.18.0	ALL-15-003-3	UPDATE	Ta max	0.15
06/19/2024	3.27.0	MCR-61-008-8	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MCR-61-008-8	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MCR-61-008-8	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MCR-61-008-8	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MCR-61-008-8	UPDATE	Ta min	0
06/19/2024	3.27.0	MCR-61-008-8	UPDATE	Ta max	0.01
06/19/2024	3.27.0	MCR-61-008-8	UPDATE	Annotation	Calculate the percentage S-CHIP Encounter: original and adjustment, paid RX claims with an invalid billing provider NPI number	N/A
06/19/2024	3.27.0	MCR-61-008-8	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Non-missing billing provider NPI number Of the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMORBILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3	N/A
06/19/2024	3.27.0	MCR-61-008-8	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-61-007-7	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MCR-61-007-7	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MCR-61-007-7	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MCR-61-007-7	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MCR-61-007-7	UPDATE	Ta min	0
06/19/2024	3.27.0	MCR-61-007-7	UPDATE	Ta max	0.01
06/19/2024	3.27.0	MCR-61-007-7	UPDATE	Annotation	Calculate the percentage S-CHIP Encounter: original and adjustment, paid OT claims with an invalid billing provider NPI number	N/A
06/19/2024	3.27.0	MCR-61-007-7	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Non-missing billing provider NPI numberOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMOR1b. BILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3	N/A
06/19/2024	3.27.0	MCR-61-007-7	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-61-006-6	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MCR-61-006-6	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MCR-61-006-6	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MCR-61-006-6	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MCR-61-006-6	UPDATE	Ta min	0
06/19/2024	3.27.0	MCR-61-006-6	UPDATE	Ta max	0.01
06/19/2024	3.27.0	MCR-61-006-6	UPDATE	Annotation	Calculate the percentage S-CHIP Encounter: original and adjustment, paid LT claims with an invalid billing provider NPI number	N/A
06/19/2024	3.27.0	MCR-61-006-6	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Non-missing billing provider NPI numberOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMOR1b. BILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3	N/A
06/19/2024	3.27.0	MCR-61-006-6	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-61-005-5	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MCR-61-005-5	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MCR-61-005-5	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MCR-61-005-5	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MCR-61-005-5	UPDATE	Ta min	0
06/19/2024	3.27.0	MCR-61-005-5	UPDATE	Ta max	0.01
06/19/2024	3.27.0	MCR-61-005-5	UPDATE	Annotation	Calculate the percentage S-CHIP Encounter: original and adjustment, paid IP claims with an invalid billing provider NPI number	N/A
06/19/2024	3.27.0	MCR-61-005-5	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Non-missing billing provider NPI numberOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMOR1b. BILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3	N/A
06/19/2024	3.27.0	MCR-61-005-5	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-61-003-3	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MCR-61-003-3	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MCR-61-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MCR-61-003-3	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MCR-61-003-3	UPDATE	Ta min	0
06/19/2024	3.27.0	MCR-61-003-3	UPDATE	Ta max	0.05
06/19/2024	3.27.0	MCR-61-003-3	UPDATE	Annotation	Calculate the percentage of S-CHIP Encounter: original and adjustment, paid OT claims with a non-missing billing provider taxonomy that is equal to an invalid value	N/A
06/19/2024	3.27.0	MCR-61-003-3	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Count of claims with an invalid billing provider taxonomyOf the claims that meet the criteria from STEP 3, count claims where BILLING-PROV-TAXONOMY is not equal to a valid valueSTEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
06/19/2024	3.27.0	MCR-61-003-3	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-61-002-2	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MCR-61-002-2	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MCR-61-002-2	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MCR-61-002-2	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MCR-61-002-2	UPDATE	Ta min	0
06/19/2024	3.27.0	MCR-61-002-2	UPDATE	Ta max	0.05
06/19/2024	3.27.0	MCR-61-002-2	UPDATE	Annotation	Calculate the percentage of S-CHIP Encounter: original and adjustment, paid LT claims with a non-missing billing provider taxonomy that is equal to an invalid value	N/A
06/19/2024	3.27.0	MCR-61-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Count of claims with an invalid billing provider taxonomyOf the claims that meet the criteria from STEP 3, count claims where BILLING-PROV-TAXONOMY is not equal to a valid valueSTEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
06/19/2024	3.27.0	MCR-61-002-2	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-61-001-1	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MCR-61-001-1	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MCR-61-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MCR-61-001-1	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MCR-61-001-1	UPDATE	Ta min	0
06/19/2024	3.27.0	MCR-61-001-1	UPDATE	Ta max	0.05
06/19/2024	3.27.0	MCR-61-001-1	UPDATE	Annotation	Calculate the percentage of S-CHIP Encounter: original and adjustment, paid IP claims with a non-missing billing provider taxonomy that is equal to an invalid value	N/A
06/19/2024	3.27.0	MCR-61-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Count of claims with an invalid billing provider taxonomyOf the claims that meet the criteria from STEP 3, count claims where BILLING-PROV-TAXONOMY is not equal to a valid valueSTEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
06/19/2024	3.27.0	MCR-61-001-1	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-60-008-8	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MCR-60-008-8	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MCR-60-008-8	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MCR-60-008-8	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MCR-60-008-8	UPDATE	Ta min	0
06/19/2024	3.27.0	MCR-60-008-8	UPDATE	Ta max	0.01
06/19/2024	3.27.0	MCR-60-008-8	UPDATE	Annotation	Calculate the percentage Medicaid Encounter: original and adjustment, paid RX claims with an invalid billing provider NPI number	N/A
06/19/2024	3.27.0	MCR-60-008-8	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Non-missing billing provider NPI numberOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMOR1b. BILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3	N/A
06/19/2024	3.27.0	MCR-60-008-8	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-60-007-7	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MCR-60-007-7	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MCR-60-007-7	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MCR-60-007-7	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MCR-60-007-7	UPDATE	Ta min	0
06/19/2024	3.27.0	MCR-60-007-7	UPDATE	Ta max	0.01
06/19/2024	3.27.0	MCR-60-007-7	UPDATE	Annotation	Calculate the percentage Medicaid Encounter: original and adjustment, paid OT claims with an invalid billing provider NPI number	N/A
06/19/2024	3.27.0	MCR-60-007-7	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Non-missing billing provider NPI numberOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMOR1b. BILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3	N/A
06/19/2024	3.27.0	MCR-60-007-7	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-60-006-6	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MCR-60-006-6	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MCR-60-006-6	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MCR-60-006-6	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MCR-60-006-6	UPDATE	Ta min	0
06/19/2024	3.27.0	MCR-60-006-6	UPDATE	Ta max	0.01
06/19/2024	3.27.0	MCR-60-006-6	UPDATE	Annotation	Calculate the percentage Medicaid Encounter: original and adjustment, paid LT claims with an invalid billing provider NPI number	N/A
06/19/2024	3.27.0	MCR-60-006-6	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Non-missing billing provider NPI number Of the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMOR1b. BILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3	N/A
06/19/2024	3.27.0	MCR-60-006-6	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-60-005-5	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MCR-60-005-5	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MCR-60-005-5	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MCR-60-005-5	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MCR-60-005-5	UPDATE	Ta min	0
06/19/2024	3.27.0	MCR-60-005-5	UPDATE	Ta max	0.01
06/19/2024	3.27.0	MCR-60-005-5	UPDATE	Annotation	Calculate the percentage Medicaid Encounter: original and adjustment, paid IP claims with an invalid billing provider NPI number	N/A
06/19/2024	3.27.0	MCR-60-005-5	UPDATE	Specification	STEP 1: Active non-duplicate IP paid claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-INDSTEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Non-missing billing provider NPI numberOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMOR1b. BILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3	N/A
06/19/2024	3.27.0	MCR-60-005-5	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-60-003-3	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MCR-60-003-3	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MCR-60-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MCR-60-003-3	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MCR-60-003-3	UPDATE	Ta min	0
06/19/2024	3.27.0	MCR-60-003-3	UPDATE	Ta max	0.05
06/19/2024	3.27.0	MCR-60-003-3	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original and adjustment, paid OT claims with a non-missing billing provider taxonomy that is equal to an invalid value	N/A
06/19/2024	3.27.0	MCR-60-003-3	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Count of claims with an invalid billing provider taxonomyOf the claims that meet the criteria from STEP 3, count claims where BILLING-PROV-TAXONOMY is not equal to a valid valueSTEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
06/19/2024	3.27.0	MCR-60-003-3	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	Ta min	0
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	Ta max	0.05
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original and adjustment, paid LT claims with a non-missing billing provider taxonomy that is equal to an invalid value	N/A
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Count of claims with an invalid billing provider taxonomyOf the claims that meet the criteria from STEP 3, count claims where BILLING-PROV-TAXONOMY is not equal to a valid valueSTEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	MCR-60-001-1	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MCR-60-001-1	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MCR-60-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MCR-60-001-1	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MCR-60-001-1	UPDATE	Ta min	0
06/19/2024	3.27.0	MCR-60-001-1	UPDATE	Ta max	0.05
06/19/2024	3.27.0	MCR-60-001-1	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original and adjustment, paid IP claims with a non-missing billing provider taxonomy that is equal to an invalid value	N/A
06/19/2024	3.27.0	MCR-60-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Count of claims with an invalid billing provider taxonomyOf the claims that meet the criteria from STEP 3, count claims where BILLING-PROV-TAXONOMY is not equal to a valid valueSTEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
06/19/2024	3.27.0	MCR-60-001-1	UPDATE	Focus area	Managed care	N/A
06/19/2024	3.27.0	FFS-51-008-8	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	FFS-51-008-8	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	FFS-51-008-8	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	FFS-51-008-8	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	FFS-51-008-8	UPDATE	Ta min	0
06/19/2024	3.27.0	FFS-51-008-8	UPDATE	Ta max	0.01
06/19/2024	3.27.0	FFS-51-008-8	UPDATE	Annotation	Calculate the percentage S-CHIP FFS: original and adjustment, paid RX claims with an invalid billing provider NPI number	N/A
06/19/2024	3.27.0	FFS-51-008-8	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Non-missing billing provider NPI numberOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMOR1b. BILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3	N/A
06/19/2024	3.27.0	FFS-51-007-7	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	FFS-51-007-7	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	FFS-51-007-7	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	FFS-51-007-7	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	FFS-51-007-7	UPDATE	Ta min	0
06/19/2024	3.27.0	FFS-51-007-7	UPDATE	Ta max	0.01
06/19/2024	3.27.0	FFS-51-007-7	UPDATE	Annotation	Calculate the percentage S-CHIP FFS: original and adjustment, paid OT claims with an invalid billing provider NPI number	N/A
06/19/2024	3.27.0	FFS-51-007-7	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Non-missing billing provider NPI numberOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMOR1b. BILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3	N/A
06/19/2024	3.27.0	FFS-51-006-6	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	FFS-51-006-6	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	FFS-51-006-6	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	FFS-51-006-6	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	FFS-51-006-6	UPDATE	Ta min	0
06/19/2024	3.27.0	FFS-51-006-6	UPDATE	Ta max	0.01
06/19/2024	3.27.0	FFS-51-006-6	UPDATE	Annotation	Calculate the percentage S-CHIP FFS: original and adjustment, paid LT claims with an invalid billing provider NPI number	N/A
06/19/2024	3.27.0	FFS-51-006-6	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Non-missing billing provider NPI numberOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMOR1b. BILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3	N/A
06/19/2024	3.27.0	FFS-51-005-5	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	FFS-51-005-5	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	FFS-51-005-5	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	FFS-51-005-5	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	FFS-51-005-5	UPDATE	Ta min	0
06/19/2024	3.27.0	FFS-51-005-5	UPDATE	Ta max	0.01
06/19/2024	3.27.0	FFS-51-005-5	UPDATE	Annotation	Calculate the percentage S-CHIP FFS: original and adjustment, paid IP claims with an invalid billing provider NPI number	N/A
06/19/2024	3.27.0	FFS-51-005-5	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Non-missing billing provider NPI numberOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMOR1b. BILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3	N/A
06/19/2024	3.27.0	FFS-51-003-3	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	FFS-51-003-3	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	FFS-51-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	FFS-51-003-3	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	FFS-51-003-3	UPDATE	Ta min	0
06/19/2024	3.27.0	FFS-51-003-3	UPDATE	Ta max	0.05
06/19/2024	3.27.0	FFS-51-003-3	UPDATE	Annotation	Calculate the percentage of S-CHIP FFS: original and adjustment, paid OT claims with a non-missing billing provider taxonomy that is equal to an invalid value	N/A
06/19/2024	3.27.0	FFS-51-003-3	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Count of claims with an invalid billing provider taxonomyOf the claims that meet the criteria from STEP 3, count claims where BILLING-PROV-TAXONOMY is not equal to a valid valueSTEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
06/19/2024	3.27.0	FFS-51-002-2	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	FFS-51-002-2	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	FFS-51-002-2	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	FFS-51-002-2	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	FFS-51-002-2	UPDATE	Ta min	0
06/19/2024	3.27.0	FFS-51-002-2	UPDATE	Ta max	0.05
06/19/2024	3.27.0	FFS-51-002-2	UPDATE	Annotation	Calculate the percentage of S-CHIP FFS: original and adjustment, paid LT claims with a non-missing billing provider taxonomy that is equal to an invalid value	N/A
06/19/2024	3.27.0	FFS-51-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Count of claims with an invalid billing provider taxonomyOf the claims that meet the criteria from STEP 3, count claims where BILLING-PROV-TAXONOMY is not equal to a valid valueSTEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
06/19/2024	3.27.0	FFS-51-001-1	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	FFS-51-001-1	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	FFS-51-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	FFS-51-001-1	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	FFS-51-001-1	UPDATE	Ta min	0
06/19/2024	3.27.0	FFS-51-001-1	UPDATE	Ta max	0.05
06/19/2024	3.27.0	FFS-51-001-1	UPDATE	Annotation	Calculate the percentage of S-CHIP FFS: original and adjustment, paid IP claims with a non-missing billing provider taxonomy that is equal to an invalid value	N/A
06/19/2024	3.27.0	FFS-51-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Count of claims with an invalid billing provider taxonomyOf the claims that meet the criteria from STEP 3, count claims where BILLING-PROV-TAXONOMY is not equal to a valid valueSTEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
06/19/2024	3.27.0	FFS-50-008-8	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	FFS-50-008-8	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	FFS-50-008-8	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	FFS-50-008-8	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	FFS-50-008-8	UPDATE	Ta min	0
06/19/2024	3.27.0	FFS-50-008-8	UPDATE	Ta max	0.01
06/19/2024	3.27.0	FFS-50-008-8	UPDATE	Annotation	Calculate the percentage Medicaid FFS: original and adjustment, paid RX claims with an invalid billing provider NPI number	N/A
06/19/2024	3.27.0	FFS-50-008-8	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Non-missing billing provider NPI numberOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMOR1b. BILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3	N/A
06/19/2024	3.27.0	FFS-50-007-7	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	FFS-50-007-7	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	FFS-50-007-7	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	FFS-50-007-7	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	FFS-50-007-7	UPDATE	Ta min	0
06/19/2024	3.27.0	FFS-50-007-7	UPDATE	Ta max	0.01
06/19/2024	3.27.0	FFS-50-007-7	UPDATE	Annotation	Calculate the percentage Medicaid FFS: original and adjustment, paid OT claims with an invalid billing provider NPI number	N/A
06/19/2024	3.27.0	FFS-50-007-7	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Non-missing billing provider NPI numberOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMOR1b. BILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3	N/A
06/19/2024	3.27.0	FFS-50-006-6	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	FFS-50-006-6	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	FFS-50-006-6	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	FFS-50-006-6	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	FFS-50-006-6	UPDATE	Ta min	0
06/19/2024	3.27.0	FFS-50-006-6	UPDATE	Ta max	0.01
06/19/2024	3.27.0	FFS-50-006-6	UPDATE	Annotation	Calculate the percentage Medicaid FFS: original and adjustment, paid LT claims with an invalid billing provider NPI number	N/A
06/19/2024	3.27.0	FFS-50-006-6	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Non-missing billing provider NPI numberOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMOR1b. BILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3	N/A
06/19/2024	3.27.0	FFS-50-005-5	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	FFS-50-005-5	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	FFS-50-005-5	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	FFS-50-005-5	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	FFS-50-005-5	UPDATE	Ta min	0
06/19/2024	3.27.0	FFS-50-005-5	UPDATE	Ta max	0.01
06/19/2024	3.27.0	FFS-50-005-5	UPDATE	Annotation	Calculate the percentage Medicaid FFS: original and adjustment, paid IP claims with an invalid billing provider NPI number	N/A
06/19/2024	3.27.0	FFS-50-005-5	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Non-missing billing provider NPI numberOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMOR1b. BILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3	N/A
06/19/2024	3.27.0	FFS-50-003-3	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	FFS-50-003-3	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	FFS-50-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	FFS-50-003-3	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	FFS-50-003-3	UPDATE	Ta min	0
06/19/2024	3.27.0	FFS-50-003-3	UPDATE	Ta max	0.05
06/19/2024	3.27.0	FFS-50-003-3	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original and adjustment, paid OT claims with a non-missing billing provider taxonomy that is equal to an invalid value	N/A
06/19/2024	3.27.0	FFS-50-003-3	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Count of claims with an invalid billing provider taxonomyOf the claims that meet the criteria from STEP 3, count claims where BILLING-PROV-TAXONOMY is not equal to a valid valueSTEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
06/19/2024	3.27.0	FFS-50-002-2	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	FFS-50-002-2	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	FFS-50-002-2	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	FFS-50-002-2	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	FFS-50-002-2	UPDATE	Ta min	0
06/19/2024	3.27.0	FFS-50-002-2	UPDATE	Ta max	0.05
06/19/2024	3.27.0	FFS-50-002-2	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original and adjustment, paid LT claims with a non-missing billing provider taxonomy that is equal to an invalid value	N/A
06/19/2024	3.27.0	FFS-50-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Count of claims with an invalid billing provider taxonomyOf the claims that meet the criteria from STEP 3, count claims where BILLING-PROV-TAXONOMY is not equal to a valid valueSTEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
06/19/2024	3.27.0	FFS-50-001-1	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	FFS-50-001-1	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	FFS-50-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	FFS-50-001-1	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	FFS-50-001-1	UPDATE	Ta min	0
06/19/2024	3.27.0	FFS-50-001-1	UPDATE	Ta max	0.05
06/19/2024	3.27.0	FFS-50-001-1	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original and adjustment, paid IP claims with a non-missing billing provider taxonomy that is equal to an invalid value	N/A
06/19/2024	3.27.0	FFS-50-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Count of claims with an invalid billing provider taxonomyOf the claims that meet the criteria from STEP 3, count claims where BILLING-PROV-TAXONOMY is not equal to a valid valueSTEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
06/19/2024	3.27.0	EL-6-027-27	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	EL-6-027-27	UPDATE	Category	Beneficiary eligibility	N/A
06/19/2024	3.27.0	EL-6-027-27	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	EL-6-027-27	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	EL-6-027-27	UPDATE	Ta min	0
06/19/2024	3.27.0	EL-6-027-27	UPDATE	Ta max	0.01
06/19/2024	3.27.0	EL-6-027-27	UPDATE	Annotation	Calculate the percentage who have a partial dual code in the dual eligible code element but do not have the dual indicator in their restricted benefits code	N/A
06/19/2024	3.27.0	EL-6-027-27	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Partial dualsOf the MSIS IDs which meet the criteria from STEP 2, restrict to those with a partial dual indicated in their dual eligible code :1. DUAL-ELIGIBLE-CODE = ("01" or "03" or "05" or "06")STEP 4: Not restricted benefit dualsOf the MSIS IDs that meet the criteria from STEP 3, further refine the population that satisfy the following criteria:1. RESTRICTED-BENEFITS-CODE is not equal to "3" or "G" or is missingSTEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	N/A
06/19/2024	3.27.0	EL-6-026-26	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	EL-6-026-26	UPDATE	Category	Beneficiary eligibility	N/A
06/19/2024	3.27.0	EL-6-026-26	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	EL-6-026-26	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	EL-6-026-26	UPDATE	Ta min	0
06/19/2024	3.27.0	EL-6-026-26	UPDATE	Ta max	0.01
06/19/2024	3.27.0	EL-6-026-26	UPDATE	Annotation	Calculate the percentage of RBC dual eligibles who do not have a partial dual code in the dual eligible code element	N/A
06/19/2024	3.27.0	EL-6-026-26	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Restricted benefit dualsOf the MSIS IDs which meet the criteria from STEP 2, restrict to those that are RBC duals:1. RESTRICTED-BENEFITS-CODE = "3" or "G"STEP 4: No partial dual codeOf the MSIS IDs that meet the criteria from STEP 3, further refine the population that satisfy the following criteria:1. DUAL-ELIGIBLE-CODE is not equal to ("01", "03", "05", "06") or is missingSTEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	N/A
02/02/2024	3.18.0	EL-3-017-22	UPDATE	Focus area	N/A	Unwinding
02/02/2024	3.18.0	ALL-16-008-8	UPDATE	Priority	Critical	N/A
02/02/2024	3.18.0	ALL-16-008-8	UPDATE	Category	File integrity	N/A
02/02/2024	3.18.0	ALL-16-008-8	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	ALL-16-008-8	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	ALL-16-008-8	UPDATE	Ta min	0
02/02/2024	3.18.0	ALL-16-008-8	UPDATE	Ta max	0.001
02/02/2024	3.18.0	ALL-16-007-7	UPDATE	Priority	Critical	N/A
02/02/2024	3.18.0	ALL-16-007-7	UPDATE	Category	File integrity	N/A
02/02/2024	3.18.0	ALL-16-007-7	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	ALL-16-007-7	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	ALL-16-007-7	UPDATE	Ta min	0
02/02/2024	3.18.0	ALL-16-007-7	UPDATE	Ta max	0.001
02/02/2024	3.18.0	ALL-16-006-6	UPDATE	Priority	Critical	N/A
02/02/2024	3.18.0	ALL-16-006-6	UPDATE	Category	File integrity	N/A
02/02/2024	3.18.0	ALL-16-006-6	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	ALL-16-006-6	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	ALL-16-006-6	UPDATE	Ta min	0
02/02/2024	3.18.0	ALL-16-006-6	UPDATE	Ta max	0.001
02/02/2024	3.18.0	ALL-16-005-5	UPDATE	Priority	Critical	N/A
02/02/2024	3.18.0	ALL-16-005-5	UPDATE	Category	File integrity	N/A
02/02/2024	3.18.0	ALL-16-005-5	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	ALL-16-005-5	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	ALL-16-005-5	UPDATE	Ta min	0
02/02/2024	3.18.0	ALL-16-005-5	UPDATE	Ta max	0.001
02/02/2024	3.18.0	ALL-16-004-4	UPDATE	Priority	Critical	N/A
02/02/2024	3.18.0	ALL-16-004-4	UPDATE	Category	File integrity	N/A
02/02/2024	3.18.0	ALL-16-004-4	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	ALL-16-004-4	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	ALL-16-004-4	UPDATE	Ta min	0
02/02/2024	3.18.0	ALL-16-004-4	UPDATE	Ta max	0.001
02/02/2024	3.18.0	ALL-16-003-3	UPDATE	Priority	Critical	N/A
02/02/2024	3.18.0	ALL-16-003-3	UPDATE	Category	File integrity	N/A
02/02/2024	3.18.0	ALL-16-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	ALL-16-003-3	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	ALL-16-003-3	UPDATE	Ta min	0
02/02/2024	3.18.0	ALL-16-003-3	UPDATE	Ta max	0.001
02/02/2024	3.18.0	ALL-16-002-2	UPDATE	Priority	Critical	N/A
02/02/2024	3.18.0	ALL-16-002-2	UPDATE	Category	File integrity	N/A
02/02/2024	3.18.0	ALL-16-002-2	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	ALL-16-002-2	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	ALL-16-002-2	UPDATE	Ta min	0
02/02/2024	3.18.0	ALL-16-002-2	UPDATE	Ta max	0.001
02/02/2024	3.18.0	ALL-16-001-1	UPDATE	Priority	Critical	N/A
02/02/2024	3.18.0	ALL-16-001-1	UPDATE	Category	File integrity	N/A
02/02/2024	3.18.0	ALL-16-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	ALL-16-001-1	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	ALL-16-001-1	UPDATE	Ta min	0
02/02/2024	3.18.0	ALL-16-001-1	UPDATE	Ta max	0.001
02/02/2024	3.18.0	ALL-15-001-1	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	ALL-15-001-1	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	ALL-15-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	ALL-15-001-1	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	ALL-15-001-1	UPDATE	Ta min	0
02/02/2024	3.18.0	ALL-15-001-1	UPDATE	Ta max	0.001
11/15/2023	3.16.0	ALL-13-003-5	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT_IND = "0"STEP 3: Non-missing admission dateOf the claims that meet the criteria from STEP 2, restrict to non-missing ADMISSION-DATESTEP 4: Link claims to enrollment time spanKeep all claims from STEP 3 for which the MSIS ID on the claim is also found on an ENROLLMENT-TIME-SPAN-ELG00021 segmentSTEP 5: Alien during date of serviceLink MSIS-IDs from the claims in STEP 4 to the ELIGIBILITY-DETERMINANTS-ELG00005 file segment and keep segments that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. RESTRICTED-BENEFIT-CODE = "2"3. Claims ADMISSION-DATE>= ELIGIBILITY-DETERMINANT-EFF-DATE4. Claims ADMISSION-DATE <= ELIGIBILITY-DETERMINANT-END-DATE OR ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 5, limit to unique MSIS-IDsSTEP 7: Non-emergency room and non-pregnancy related servicesOf the claims that meet the criteria from STEP 5, restrict to claims with that do NOT have emergency room revenue codes or pregnancy-related diagnosis codes or procedure codes:NOT (1a. REVENUE-CODE equal to ("450", "451", "452", "453", "454", "455", "456", "457", "458", "459", "0450", "0451", "0452", "0453", "0454", "0455", "0456", "0457", "0458", "0459" ,“0981”,“0720”, “0721”, “0722”, “0723”, “0724”, “0729”)OR2a. DIAGNOSIS-CODE-1 through DIAGNOSIS-CODE-12 is found in the Pregnancy CodeSet tab for ICD-10-CM code typesOR3a. PROCEDURE-CODE-1 through PROCEDURE-CODE-6 is found in the Pregnancy CodeSet tab for ICD-10-PCM code types)STEP 8: Calculate percentageDivide the count of unique MSIS-IDs from STEP 7 by the count of MSIS-IDs from STEP 6	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT_IND = "0"STEP 3: Non-missing admission dateOf the claims that meet the criteria from STEP 2, restrict to non-missing ADMISSION-DATESTEP 4: Link claims to enrollment time spanKeep all claims from STEP 3 for which the MSIS ID on the claim is also found on an ENROLLMENT-TIME-SPAN-ELG00021 segmentSTEP 5: Alien during date of serviceLink MSIS-IDs from the claims in STEP 4 to the ELIGIBILITY-DETERMINANTS-ELG00005 file segment and keep segments that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. RESTRICTED-BENEFIT-CODE = "2"3. Claims ADMISSION-DATE>= ELIGIBILITY-DETERMINANT-EFF-DATE4. Claims ADMISSION-DATE <= ELIGIBILITY-DETERMINANT-END-DATE OR ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 5, limit to unique MSIS-IDsSTEP 7: Non-emergency room and non-pregnancy related servicesOf the claims that meet the criteria from STEP 5, restrict to claims with that do NOT have emergency room revenue codes or pregnancy-related diagnosis codes or procedure codes:NOT (1a. REVENUE-CODE equal to ("450", "451", "452", "453", "454", "455", "456", "457", "458", "459", "0450", "0451", "0452", "0453", "0454", "0455", "0456", "0457", "0458", "0459" ,“0981”,“0720”, “0721”, “0722”, “0723”, “0724”, “0729”)OR2a. DIAGNOSIS-CODE-1 through DIAGNOSIS-CODE-12 is found in the Pregnancy CodeSet tab for ICD-10-CM code typesOR3a. PROCEDURE-CODE-1 through PROCEDURE-CODE-6 is found in the Pregnancy CodeSet tab for ICD-10-PCM code types)STEP 8: Calculate percentageDivide the count of unique MSIS-IDs from STEP 7 by the count of MSIS-IDs from STEP 6
11/15/2023	3.16.0	MIS-30-003-3	UPDATE	Priority	High	N/A
11/15/2023	3.16.0	MIS-30-003-3	UPDATE	Category	Utilization	N/A
11/15/2023	3.16.0	MIS-30-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-30-003-3	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-30-003-3	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-30-003-3	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-30-003-3	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-30-003-3	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Capitation Payment: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2" or "B"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
02/02/2024	3.18.0	MIS-30-002-2	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-30-002-2	UPDATE	Category	Expenditures	N/A
02/02/2024	3.18.0	MIS-30-002-2	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-30-002-2	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-30-002-2	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-30-002-2	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-30-001-1	UPDATE	Priority	High	N/A
11/15/2023	3.16.0	MIS-30-001-1	UPDATE	Category	Utilization	N/A
11/15/2023	3.16.0	MIS-30-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-30-001-1	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-30-001-1	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-30-001-1	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-30-001-1	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-30-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Capitation Payment: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2" or "B"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
11/15/2023	3.16.0	MIS-29-002-2	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	MIS-29-002-2	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	MIS-29-002-2	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-29-002-2	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-29-002-2	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-29-002-2	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-29-002-2	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-29-002-2	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Capitation Payment: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2" or "B"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
11/15/2023	3.16.0	MIS-29-001-1	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	MIS-29-001-1	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	MIS-29-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-29-001-1	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-29-001-1	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-29-001-1	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-29-001-1	UPDATE	Annotation	Numeric	N/A
11/15/2023	3.16.0	MIS-29-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Capitation Payment: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2" or "B"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
02/02/2024	3.18.0	MIS-28-001-1	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-28-001-1	UPDATE	Category	Expenditures	N/A
02/02/2024	3.18.0	MIS-28-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-28-001-1	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-28-001-1	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-28-001-1	UPDATE	Ta max	0.1
02/02/2024	3.18.0	MIS-26-001-1	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-26-001-1	UPDATE	Category	Expenditures	N/A
02/02/2024	3.18.0	MIS-26-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-26-001-1	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-26-001-1	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-26-001-1	UPDATE	Ta max	0.1
02/02/2024	3.18.0	MIS-24-001-1	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-24-001-1	UPDATE	Category	Expenditures	N/A
02/02/2024	3.18.0	MIS-24-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-24-001-1	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-24-001-1	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-24-001-1	UPDATE	Ta max	0.1
02/02/2024	3.18.0	MIS-22-001-1	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-22-001-1	UPDATE	Category	Expenditures	N/A
02/02/2024	3.18.0	MIS-22-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-22-001-1	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-22-001-1	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-22-001-1	UPDATE	Ta max	0.1
02/02/2024	3.18.0	MIS-19-001-1	UPDATE	Priority	Critical	N/A
02/02/2024	3.18.0	MIS-19-001-1	UPDATE	Category	File integrity	N/A
02/02/2024	3.18.0	MIS-19-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-19-001-1	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-19-001-1	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-19-001-1	UPDATE	Ta max	0.02
02/02/2024	3.18.0	MIS-17-001-1	UPDATE	Priority	Critical	N/A
02/02/2024	3.18.0	MIS-17-001-1	UPDATE	Category	File integrity	N/A
02/02/2024	3.18.0	MIS-17-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-17-001-1	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-17-001-1	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-17-001-1	UPDATE	Ta max	0.02
02/02/2024	3.18.0	MIS-15-001-1	UPDATE	Priority	Critical	N/A
02/02/2024	3.18.0	MIS-15-001-1	UPDATE	Category	File integrity	N/A
02/02/2024	3.18.0	MIS-15-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-15-001-1	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-15-001-1	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-15-001-1	UPDATE	Ta max	0.02
02/02/2024	3.18.0	MIS-13-001-1	UPDATE	Priority	Critical	N/A
02/02/2024	3.18.0	MIS-13-001-1	UPDATE	Category	File integrity	N/A
02/02/2024	3.18.0	MIS-13-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-13-001-1	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-13-001-1	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-13-001-1	UPDATE	Ta max	0.02
11/15/2023	3.16.0	FFS-48-001-1	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	FFS-48-001-1	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	FFS-48-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	FFS-48-001-1	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	FFS-48-001-1	UPDATE	Ta min	0
11/15/2023	3.16.0	FFS-48-001-1	UPDATE	Ta max	0.05
11/15/2023	3.16.0	FFS-48-001-1	UPDATE	Annotation	The percentage of claims that are S-CHIP FFS: original and adjustment, and paid where patient status is not "Still a patient" and the discharge date is missing	N/A
11/15/2023	3.16.0	FFS-48-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"STEP 3: Patient status is not "Still a Patient"Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PATIENT-STATUS is not equal to "30"2. PATIENT-STATUS is not missingSTEP 4: Missing discharge dateOf the claims from STEP 3, select records where:1. DISCHARGE-DATE is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3	N/A
11/15/2023	3.16.0	FFS-47-001-1	UPDATE	Priority	Critical	N/A
11/15/2023	3.16.0	FFS-47-001-1	UPDATE	Category	File integrity	N/A
11/15/2023	3.16.0	FFS-47-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	FFS-47-001-1	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	FFS-47-001-1	UPDATE	Ta min	0
11/15/2023	3.16.0	FFS-47-001-1	UPDATE	Ta max	0.05
11/15/2023	3.16.0	FFS-47-001-1	UPDATE	Annotation	The percentage of claims that are Medicaid FFS: original and adjustment, and paid where patient status is not "Still a patient" and the discharge date is missing	N/A
11/15/2023	3.16.0	FFS-47-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Patient status is not "Still a Patient"Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PATIENT-STATUS is not equal to "30"2. PATIENT-STATUS is not missingSTEP 4: Missing discharge dateOf the claims from STEP 3, select records where:1. DISCHARGE-DATE is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3	N/A
02/02/2024	3.18.0	EXP-39-001-1	UPDATE	Focus area	Managed care	N/A
02/02/2024	3.18.0	EXP-37-001-1	UPDATE	Focus area	Managed care	N/A
03/27/2024	3.22.0	EL-6-023-23	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Full-benefit enrolleesOf the MSIS ID's that meet the criteria from step 2, count the unique number of MSIS IDs where:1. RESTRICTED-BENEFITS-CODE = ("1", "7", "A", "B", "D") or is missing**Note: This can include MSIS IDs from STEP 1 that did not join to an eligibility determinants segment.	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Full-benefit enrolleesOf the MSIS ID's that meet the criteria from step 2, count the unique number of MSIS IDs where:1. RESTRICTED-BENEFITS-CODE = ("1", "4", "5" "7", "A", "B", "D") or is missing**Note: This can include MSIS IDs from STEP 1 that did not join to an eligibility determinants segment.
02/02/2024	3.18.0	EL-15-002-2	UPDATE	Focus area	N/A	Unwinding
02/02/2024	3.18.0	EL-15-001-1	UPDATE	Focus area	N/A	Unwinding
11/15/2023	3.16.0	MIS-9-019-19	UPDATE	Measure name	% missing: OT-RX-CLAIM-QUANTITY-ACTUAL (CRX00003)	% missing: PRESCRIPTION-QUANTITY-ACTUAL (CRX00003)
11/15/2023	3.16.0	MIS-9-007-7	UPDATE	Measure name	% missing: DISPENSE-FEE (CRX00003)	% missing: DISPENSE-FEE-SUBMITTED (CRX00003)
11/15/2023	3.16.0	MIS-9-005-5	UPDATE	Measure name	% missing: COPAY-AMT (CRX00003)	% missing: BENEFICIARY-COPAYMENT-PAID-AMOUNT (CRX00003)
11/15/2023	3.16.0	MIS-8-005-5	UPDATE	Measure name	% missing: BENEFICIARY-DEDUCTIBLE-AMOUNT (CRX00002)	% missing: TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT (CRX00002)
11/15/2023	3.16.0	MIS-8-004-4	UPDATE	Measure name	% missing: BENEFICIARY-COPAYMENT-AMOUNT (CRX00002)	% missing: TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT (CRX00002)
11/15/2023	3.16.0	MIS-8-003-3	UPDATE	Measure name	% missing: BENEFICIARY-COINSURANCE-AMOUNT (CRX00002)	% missing: TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT (CRX00002)
11/15/2023	3.16.0	MIS-7-020-20	UPDATE	Measure name	% missing: OT-RX-CLAIM-QUANTITY-ACTUAL (COT00003)	% missing: SERVICE-QUANTITY-ACTUAL (COT00003)
11/15/2023	3.16.0	MIS-7-005-5	UPDATE	Measure name	% missing: COPAY-AMT (COT00003)	% missing: BENEFICIARY-COPAYMENT-PAID-AMOUNT (COT00003)
11/15/2023	3.16.0	MIS-6-006-6	UPDATE	Measure name	% missing: BENEFICIARY-DEDUCTIBLE-AMOUNT (COT00002)	% missing: TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT (COT00002)
11/15/2023	3.16.0	MIS-6-005-5	UPDATE	Measure name	% missing: BENEFICIARY-COPAYMENT-AMOUNT (COT00002)	% missing: TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT (COT00002)
11/15/2023	3.16.0	MIS-6-004-4	UPDATE	Measure name	% missing: BENEFICIARY-COINSURANCE-AMOUNT (COT00002)	% missing: TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT (COT00002)
11/15/2023	3.16.0	MIS-4-006-6	UPDATE	Measure name	% missing: BENEFICIARY-DEDUCTIBLE-AMOUNT (CLT00002)	% missing: TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT (CLT00002)
11/15/2023	3.16.0	MIS-4-005-5	UPDATE	Measure name	% missing: BENEFICIARY-COPAYMENT-AMOUNT (CLT00002)	% missing: TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT (CLT00002)
11/15/2023	3.16.0	MIS-4-004-4	UPDATE	Measure name	% missing: BENEFICIARY-COINSURANCE-AMOUNT (CLT00002)	% missing: TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT (CLT00002)
11/15/2023	3.16.0	MIS-2-007-7	UPDATE	Measure name	% missing: BENEFICIARY-DEDUCTIBLE-AMOUNT (CIP00002)	% missing: TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT (CIP00002)
11/15/2023	3.16.0	MIS-2-006-6	UPDATE	Measure name	% missing: BENEFICIARY-COPAYMENT-AMOUNT (CIP00002)	% missing: TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT (CIP00002)
11/15/2023	3.16.0	MIS-2-005-5	UPDATE	Measure name	% missing: BENEFICIARY-COINSURANCE-AMOUNT (CIP00002)	% missing: TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT (CIP00002)
03/27/2024	3.22.0	MIS-11-039-39	UPDATE	Priority	High	N/A
03/27/2024	3.22.0	MIS-11-039-39	UPDATE	Category	Provider characteristics	N/A
03/27/2024	3.22.0	MIS-11-039-39	UPDATE	For ta comprehensive	TA- Inferential	No
03/27/2024	3.22.0	MIS-11-039-39	UPDATE	For ta inferential	Yes	No
03/27/2024	3.22.0	MIS-11-039-39	UPDATE	Ta min	0
03/27/2024	3.22.0	MIS-11-039-39	UPDATE	Ta max	0.02
03/27/2024	3.22.0	MIS-11-039-39	UPDATE	Annotation	Alphanumeric	N/A
03/27/2024	3.22.0	MIS-11-039-39	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
03/27/2024	3.22.0	MIS-11-038-38	UPDATE	Priority	High	N/A
03/27/2024	3.22.0	MIS-11-038-38	UPDATE	Category	Provider characteristics	N/A
03/27/2024	3.22.0	MIS-11-038-38	UPDATE	For ta comprehensive	TA- Inferential	No
03/27/2024	3.22.0	MIS-11-038-38	UPDATE	For ta inferential	Yes	No
03/27/2024	3.22.0	MIS-11-038-38	UPDATE	Ta min	0
03/27/2024	3.22.0	MIS-11-038-38	UPDATE	Ta max	0.02
03/27/2024	3.22.0	MIS-11-038-38	UPDATE	Annotation	Alphanumeric	N/A
03/27/2024	3.22.0	MIS-11-038-38	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
03/27/2024	3.22.0	MIS-11-035-35	UPDATE	Priority	High	N/A
03/27/2024	3.22.0	MIS-11-035-35	UPDATE	Category	Provider identifiers	N/A
03/27/2024	3.22.0	MIS-11-035-35	UPDATE	For ta comprehensive	TA- Inferential	No
03/27/2024	3.22.0	MIS-11-035-35	UPDATE	For ta inferential	Yes	No
03/27/2024	3.22.0	MIS-11-035-35	UPDATE	Ta min	0
03/27/2024	3.22.0	MIS-11-035-35	UPDATE	Ta max	0.02
03/27/2024	3.22.0	MIS-11-035-35	UPDATE	Annotation	Alphanumeric	N/A
03/27/2024	3.22.0	MIS-11-035-35	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
03/27/2024	3.22.0	MIS-11-034-34	UPDATE	Priority	High	N/A
03/27/2024	3.22.0	MIS-11-034-34	UPDATE	Category	Provider identifiers	N/A
03/27/2024	3.22.0	MIS-11-034-34	UPDATE	For ta comprehensive	TA- Inferential	No
03/27/2024	3.22.0	MIS-11-034-34	UPDATE	For ta inferential	Yes	No
03/27/2024	3.22.0	MIS-11-034-34	UPDATE	Ta min	0
03/27/2024	3.22.0	MIS-11-034-34	UPDATE	Ta max	0.02
03/27/2024	3.22.0	MIS-11-034-34	UPDATE	Annotation	Alphanumeric	N/A
03/27/2024	3.22.0	MIS-11-034-34	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
03/27/2024	3.22.0	MIS-11-032-32	UPDATE	Priority	High	N/A
03/27/2024	3.22.0	MIS-11-032-32	UPDATE	Category	Provider identifiers	N/A
03/27/2024	3.22.0	MIS-11-032-32	UPDATE	For ta comprehensive	TA- Inferential	No
03/27/2024	3.22.0	MIS-11-032-32	UPDATE	For ta inferential	Yes	No
03/27/2024	3.22.0	MIS-11-032-32	UPDATE	Ta min	0
03/27/2024	3.22.0	MIS-11-032-32	UPDATE	Ta max	0.02
03/27/2024	3.22.0	MIS-11-032-32	UPDATE	Annotation	Numeric	N/A
03/27/2024	3.22.0	MIS-11-032-32	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX) STEP 2: Numeric missing flagCreate a binary flag called Numeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 3: All numeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Numeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
03/27/2024	3.22.0	MIS-11-031-31	UPDATE	Priority	High	N/A
03/27/2024	3.22.0	MIS-11-031-31	UPDATE	Category	Provider identifiers	N/A
03/27/2024	3.22.0	MIS-11-031-31	UPDATE	For ta comprehensive	TA- Inferential	No
03/27/2024	3.22.0	MIS-11-031-31	UPDATE	For ta inferential	Yes	No
03/27/2024	3.22.0	MIS-11-031-31	UPDATE	Ta min	0
03/27/2024	3.22.0	MIS-11-031-31	UPDATE	Ta max	0.02
03/27/2024	3.22.0	MIS-11-031-31	UPDATE	Annotation	Alphanumeric	N/A
03/27/2024	3.22.0	MIS-11-031-31	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
11/15/2023	3.16.0	MIS-11-010-10	UPDATE	Priority	Medium	N/A
11/15/2023	3.16.0	MIS-11-010-10	UPDATE	Category	Provider identifiers	N/A
11/15/2023	3.16.0	MIS-11-010-10	UPDATE	For ta comprehensive	TA- Inferential	No
11/15/2023	3.16.0	MIS-11-010-10	UPDATE	For ta inferential	Yes	No
11/15/2023	3.16.0	MIS-11-010-10	UPDATE	Ta min	0
11/15/2023	3.16.0	MIS-11-010-10	UPDATE	Ta max	0.02
11/15/2023	3.16.0	MIS-11-010-10	UPDATE	Threshold minimum	0	N/A
11/15/2023	3.16.0	MIS-11-010-10	UPDATE	Threshold maximum	0.02	N/A
03/27/2024	3.22.0	MIS-11-003-3	UPDATE	Priority	High	N/A
03/27/2024	3.22.0	MIS-11-003-3	UPDATE	Category	Provider characteristics	N/A
03/27/2024	3.22.0	MIS-11-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
03/27/2024	3.22.0	MIS-11-003-3	UPDATE	For ta inferential	Yes	No
03/27/2024	3.22.0	MIS-11-003-3	UPDATE	Ta min	0
03/27/2024	3.22.0	MIS-11-003-3	UPDATE	Ta max	0.02
03/27/2024	3.22.0	MIS-11-003-3	UPDATE	Annotation	Alphanumeric	N/A
03/27/2024	3.22.0	MIS-11-003-3	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
11/15/2023	3.16.0	MIS-1-073-73	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1NOTE:The following value(s) should also be treated as missing for ETHNICITY-CODE (ELG000015):6	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1NOTE:The following value(s) should also be treated as missing for ETHNICITY-CODE (ELG000015):6The following value(s) should not be treated as missing for ETHNICITY-CODE (ELG000015):0
03/27/2024	3.22.0	MIS-1-010-10	UPDATE	Priority	High	N/A
03/27/2024	3.22.0	MIS-1-010-10	UPDATE	Category	Beneficiary demographics	N/A
03/27/2024	3.22.0	MIS-1-010-10	UPDATE	For ta comprehensive	TA- Inferential	No
03/27/2024	3.22.0	MIS-1-010-10	UPDATE	For ta inferential	Yes	No
03/27/2024	3.22.0	MIS-1-010-10	UPDATE	Ta min	0
03/27/2024	3.22.0	MIS-1-010-10	UPDATE	Ta max	0.02
03/27/2024	3.22.0	MIS-1-010-10	UPDATE	Annotation	Alphanumeric	N/A
03/27/2024	3.22.0	MIS-1-010-10	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
03/27/2024	3.22.0	MIS-1-008-8	UPDATE	Priority	High	N/A
03/27/2024	3.22.0	MIS-1-008-8	UPDATE	Category	Beneficiary demographics	N/A
03/27/2024	3.22.0	MIS-1-008-8	UPDATE	For ta comprehensive	TA- Inferential	No
03/27/2024	3.22.0	MIS-1-008-8	UPDATE	For ta inferential	Yes	No
03/27/2024	3.22.0	MIS-1-008-8	UPDATE	Ta min	0
03/27/2024	3.22.0	MIS-1-008-8	UPDATE	Ta max	0.2
03/27/2024	3.22.0	MIS-1-008-8	UPDATE	Annotation	Alphanumeric	N/A
03/27/2024	3.22.0	MIS-1-008-8	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (ELG000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the MSIS-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular MSIS-IDSTEP 4: Calculate percentageDivide the count of unique MSIS-IDs from STEP 3 by the count of unique MSIS-IDs from STEP 1	N/A
02/02/2024	3.18.0	MCR-54-009-9	UPDATE	Focus area	Managed care	N/A
11/15/2023	3.16.0	PRV-2-002-2	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missing STEP 2: Provider identifier is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROV-IDENTIFIER-PRV00005 by keeping records that satisfy the following criteria:1a. PROV-IDENTIFIER-EFF-DATE <= last day of the reporting month2a. PROV-IDENTIFIER-END-DATE >= last day of the reporting month OR missingOR1b. PROV-IDENTIFIER-EFF-DATE is missing2b. PROV-IDENTIFIER-END-DATE is missingSTEP 3: Provider classification type is "NPI"Of the providers that meet the criteria from STEP 2, keep records that satisfy the following criteria: 1. PROV-IDENTIFIER-TYPE = 2STEP 4: Calculate percent that that have NPIDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count from STEP 2	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missing STEP 2: Provider identifier is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROV-IDENTIFIER-PRV00005 by keeping records that satisfy the following criteria:1a. PROV-IDENTIFIER-EFF-DATE <= last day of the reporting month2a. PROV-IDENTIFIER-END-DATE >= last day of the reporting month OR missingOR1b. PROV-IDENTIFIER-EFF-DATE is missing2b. PROV-IDENTIFIER-END-DATE is missingSTEP 3: Provider classification type is "NPI"Of the providers that meet the criteria from STEP 2, keep records that satisfy the following criteria: 1. PROV-IDENTIFIER-TYPE = 2STEP 4: Calculate percent that have NPIDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count from STEP 2
11/15/2023	3.16.0	MCR-19-008-2	UPDATE	Measure name	% of claim headers with missing OT RX Claim Quantity Actual	% of claim headers with missing Prescription Quantity Actual
11/15/2023	3.16.0	MCR-19-008-2	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing OT RX Claim QuantityOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. OT-RX-CLAIM-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing Prescription Quantity ActualOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PRESCRIPTION-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
11/15/2023	3.16.0	MCR-19-006-4	UPDATE	Measure name	% of claim headers with OT-RX-CLAIM-QUANTITY-ACTUAL = 1	% of claim headers with PRESCRIPTION-QUANTITY-ACTUAL = 1
02/02/2024	3.18.0	MCR-19-005-1	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MCR-19-005-1	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	MCR-19-005-1	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MCR-19-005-1	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MCR-19-005-1	UPDATE	Ta min	0
02/02/2024	3.18.0	MCR-19-005-1	UPDATE	Ta max	0.05
02/02/2024	3.18.0	MCR-19-005-1	UPDATE	Focus area	Managed care	N/A
11/15/2023	3.16.0	MCR-17-008-2	UPDATE	Measure name	% of claim headers with missing OT RX Claim Quantity Actual	% of claim headers with missing Prescription Quantity Actual
11/15/2023	3.16.0	MCR-17-008-2	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing OT RX Claim QuantityOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. OT-RX-CLAIM-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing Prescription Quantity ActualOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PRESCRIPTION-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
11/15/2023	3.16.0	MCR-17-007-4	UPDATE	Measure name	% of claim headers with OT-RX-CLAIM-QUANTITY-ACTUAL = 1	% of claim headers with PRESCRIPTION-QUANTITY-ACTUAL = 1
11/15/2023	3.16.0	MCR-17-007-4	UPDATE	Specification	STEP 1: Active non-duplicate paid RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3”2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. OT-RX-CLAIM-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.	STEP 1: Active non-duplicate paid RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3”2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. PRESCRIPTION-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.
02/02/2024	3.18.0	MCR-17-005-1	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MCR-17-005-1	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	MCR-17-005-1	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MCR-17-005-1	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MCR-17-005-1	UPDATE	Ta min	0
02/02/2024	3.18.0	MCR-17-005-1	UPDATE	Ta max	0.05
02/02/2024	3.18.0	MCR-17-005-1	UPDATE	Focus area	Managed care	N/A
11/15/2023	3.16.0	MCR-14-024-2	UPDATE	Measure name	% of claim headers with OT-RX-CLAIM-QUANTITY-ACTUAL = 1	% of claim headers with SERVICE-QUANTITY-ACTUAL = 1
11/15/2023	3.16.0	MCR-14-022-17	UPDATE	Measure name	% of claim lines with TYPE-OF-SERVICE = 12, 25, 26 with local service code indicator (PROCDURE-CODE = 10 - 87)	% of claim lines with TYPE-OF-SERVICE = 12, 25, 26 with local service code indicator (PROCEDURE-CODE-FLAG = 10 - 87)
11/15/2023	3.16.0	MCR-1-010-5	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status of discharged to other institutionOf the claims that meet the criteria from STEP 2, select claims with patient status of other institution:1. PATIENT-STATUS = “2” or “3” or “4” or “5” or “43” or “51” or “61” or “62” or “63” or “64” or “65” or “66” or “70” or “82” or “83” or “84” or “85” or “88” or “89” or “90” or “91” or “92” or “93” or “94” or “95”STEP 4 : Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status of discharged to other institutionOf the claims that meet the criteria from STEP 2, select claims with patient status of other institution:1. PATIENT-STATUS = “02” or “03” or “04” or “05” or “43” or “51” or “61” or “62” or “63” or “64” or “65” or “66” or “70” or “82” or “83” or “84” or “85” or “88” or “89” or “90” or “91” or “92” or “93” or “94” or “95”STEP 4 : Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.
11/15/2023	3.16.0	MCR-1-009-4	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status of discharged to homeOf the claims that meet the criteria from STEP 2, select claims with home patient status:1. PATIENT-STATUS = “1” or “6” or “8” or “50” or “81” or “86”STEP 4 : Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status of discharged to homeOf the claims that meet the criteria from STEP 2, select claims with home patient status:1. PATIENT-STATUS = “01” or “06” or “08” or “50” or “81” or “86”STEP 4 : Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.
11/15/2023	3.16.0	MCR-10-024-2	UPDATE	Measure name	% of claim headers with OT-RX-CLAIM-QUANTITY-ACTUAL = 1	% of claim headers with SERVICE-QUANTITY-ACTUAL = 1
11/15/2023	3.16.0	MCR-10-024-2	UPDATE	Specification	STEP 1: Active non-duplicated OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. OT-RX-CLAIM-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.	STEP 1: Active non-duplicated OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. SERVICE-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.
11/15/2023	3.16.0	MCR-10-022-17	UPDATE	Measure name	% of claim lines with TYPE-OF-SERVICE = 12, 25, 26 with local service code indicator (PROCDURE-CODE = 10 - 87)	% of claim lines with TYPE-OF-SERVICE = 12, 25, 26 with local service code indicator (PROCEDURE-CODE-FLAG = 10 - 87)
11/15/2023	3.16.0	FFS-9-025-2	UPDATE	Measure name	% of claim headers with OT-RX-CLAIM-QUANTITY-ACTUAL = 1	% of claim headers with SERVICE-QUANTITY-ACTUAL = 1
11/15/2023	3.16.0	FFS-9-025-2	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. OT-RX-CLAIM-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. SERVICE-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.
11/15/2023	3.16.0	FFS-9-023-17	UPDATE	Measure name	% of claim lines with TYPE-OF-SERVICE = 12, 25, 26 with local service code indicator (PROCDURE-CODE = 10 - 87)	% of claim lines with TYPE-OF-SERVICE = 12, 25, 26 with local service code indicator (PROCEDURE-CODE-FLAG = 10 - 87)
11/15/2023	3.16.0	FFS-16-008-2	UPDATE	Measure name	% of claim headers with missing OT RX Claim Quantity Actual	% of claim headers with missing Prescription Quantity Actual
11/15/2023	3.16.0	FFS-16-008-2	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing OT RX Claim QuantityOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. OT-RX-CLAIM-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing Prescription Quantity ActualOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PRESCRIPTION-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
11/15/2023	3.16.0	FFS-16-007-4	UPDATE	Measure name	% of claim headers with OT-RX-CLAIM-QUANTITY-ACTUAL = 1	% of claim headers with PRESCRIPTION-QUANTITY-ACTUAL = 1
02/02/2024	3.18.0	FFS-16-005-1	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	FFS-16-005-1	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	FFS-16-005-1	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	FFS-16-005-1	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	FFS-16-005-1	UPDATE	Ta min	0
02/02/2024	3.18.0	FFS-16-005-1	UPDATE	Ta max	0.05
11/15/2023	3.16.0	FFS-14-008-2	UPDATE	Measure name	% of claim headers with missing OT RX Claim Quantity Actual	% of claim headers with missing Prescription Quantity Actual
11/15/2023	3.16.0	FFS-14-008-2	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing OT RX Claim QuantityOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. OT-RX-CLAIM-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Missing Prescription Quantity ActualOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. PRESCRIPTION-QUANTITY-ACTUAL is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2
11/15/2023	3.16.0	FFS-14-007-4	UPDATE	Measure name	% of claim headers with OT-RX-CLAIM-QUANTITY-ACTUAL = 1	% of claim headers with PRESCRIPTION-QUANTITY-ACTUAL = 1
11/15/2023	3.16.0	FFS-14-007-4	UPDATE	Specification	STEP 1: Active non-duplicate paid RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. OT-RX-CLAIM-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2	STEP 1: Active non-duplicate paid RX records during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. PRESCRIPTION-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2
02/02/2024	3.18.0	FFS-14-005-1	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	FFS-14-005-1	UPDATE	Category	Utilization	N/A
02/02/2024	3.18.0	FFS-14-005-1	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	FFS-14-005-1	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	FFS-14-005-1	UPDATE	Ta min	0
02/02/2024	3.18.0	FFS-14-005-1	UPDATE	Ta max	0.05
11/15/2023	3.16.0	FFS-11-024-2	UPDATE	Measure name	% of claim headers with OT-RX-CLAIM-QUANTITY-ACTUAL = 1	% of claim headers with SERVICE-QUANTITY-ACTUAL = 1
11/15/2023	3.16.0	FFS-11-022-17	UPDATE	Measure name	% of claim lines with TYPE-OF-SERVICE = 12, 25, 26 with local service code indicator (PROCDURE-CODE = 10 - 87)	% of claim lines with TYPE-OF-SERVICE = 12, 25, 26 with local service code indicator (PROCEDURE-CODE-FLAG = 10 - 87)
02/26/2025	3.34.0	EXP-7-026-3	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-7-026-3	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-7-025-10	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-7-025-10	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-7-024-9	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-7-024-9	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-7-023-8	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-7-023-8	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-7-022-7	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-7-022-7	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-7-021-6	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-7-021-6	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-7-020-5	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-7-020-5	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-7-019-4	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-7-019-4	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-7-018-11	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-7-018-11	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-7-017-18	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-7-017-18	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-7-016-17	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-7-016-17	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-7-015-16	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-7-015-16	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-7-014-15	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-7-014-15	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-7-013-14	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-7-013-14	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-7-012-13	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-7-012-13	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-7-011-12	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-7-011-12	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-7-010-19	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-7-010-19	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-6-027-4	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-6-027-4	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-6-026-11	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-6-026-11	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-6-025-10	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-6-025-10	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-6-024-9	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-6-024-9	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-6-023-8	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-6-023-8	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-6-022-7	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-6-022-7	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-6-021-6	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-6-021-6	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-6-020-5	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-6-020-5	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-6-019-12	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-6-019-12	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-6-018-19	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-6-018-19	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-6-017-18	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-6-017-18	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-6-016-17	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-6-016-17	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-6-015-16	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-6-015-16	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-6-014-15	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-6-014-15	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-6-013-14	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-6-013-14	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-6-012-13	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-6-012-13	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-6-011-20	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-6-011-20	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-5-019-9	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-5-019-9	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-5-018-8	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-5-018-8	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-5-017-7	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-5-017-7	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-5-016-6	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-5-016-6	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-5-015-5	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-5-015-5	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-5-014-4	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-5-014-4	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-5-013-3	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-5-013-3	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-5-012-2	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-5-012-2	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-5-011-1	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-5-011-1	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-2-019-11	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-2-019-11	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-2-018-10	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-2-018-10	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-2-017-9	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-2-017-9	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-2-016-8	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-2-016-8	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-2-015-7	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-2-015-7	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-2-014-6	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-2-014-6	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-2-013-5	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-2-013-5	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-2-012-4	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-2-012-4	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-2-011-3	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-2-011-3	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-19-016-2	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-19-016-2	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-19-015-8	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-19-015-8	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-19-014-7	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-19-014-7	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-19-013-6	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-19-013-6	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-19-012-5	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-19-012-5	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-19-011-4	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-19-011-4	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-19-010-3	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-19-010-3	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-19-009-1	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-19-009-1	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-17-016-2	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-17-016-2	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-17-015-8	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-17-015-8	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-17-014-7	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-17-014-7	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-17-013-6	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-17-013-6	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-17-012-5	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-17-012-5	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-17-011-4	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-17-011-4	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-17-010-3	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-17-010-3	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-17-009-1	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-17-009-1	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-16-019-6	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-16-019-6	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-16-018-12	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-16-018-12	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-16-017-11	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-16-017-11	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-16-016-10	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-16-016-10	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-16-015-9	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-16-015-9	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-16-014-8	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-16-014-8	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-16-013-7	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-16-013-7	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-16-012-5	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-16-012-5	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-154-5	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-154-5	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-153-3	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-153-3	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-151-77	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-151-77	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-151-76	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-151-76	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-150-75	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-150-75	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-149-74	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-149-74	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-148-73	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-148-73	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-147-72	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-147-72	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-146-71	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-146-71	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-145-70	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-145-70	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-144-68	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-144-68	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-143-67	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-143-67	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-142-66	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-142-66	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-141-65	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-141-65	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-140-64	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-140-64	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-139-63	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-139-63	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-138-62	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-138-62	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-137-61	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-137-61	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-136-60	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-136-60	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-134-57	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-134-57	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-133-56	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-133-56	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-132-55	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-132-55	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-131-54	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-131-54	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-130-53	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-130-53	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-129-52	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-129-52	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-128-51	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-128-51	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-127-50	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-127-50	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-126-49	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-126-49	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-125-47	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-125-47	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-124-46	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-124-46	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-123-45	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-123-45	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-122-44	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-122-44	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-121-43	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-121-43	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-120-42	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-120-42	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-119-41	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-119-41	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-118-40	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-118-40	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-117-38	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-117-38	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-116-37	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-116-37	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-115-36	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-115-36	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-114-35	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-114-35	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-113-34	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-113-34	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-112-32	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-112-32	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-111-31	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-111-31	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-110-30	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-110-30	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-109-29	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-109-29	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-108-28	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-108-28	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-107-27	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-107-27	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-106-26	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-106-26	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-105-25	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-105-25	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-104-23	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-104-23	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-103-22	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-103-22	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-102-21	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-102-21	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-101-20	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-101-20	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-100-19	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-100-19	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-099-18	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-099-18	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-098-17	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-098-17	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-097-16	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-097-16	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-096-15	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-096-15	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-095-14	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-095-14	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-094-12	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-094-12	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-093-11	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-093-11	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-092-10	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-092-10	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-091-9	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-091-9	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-089-7	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-089-7	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-088-6	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-088-6	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-087-4	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-087-4	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-086-2	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-086-2	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-085-1	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-085-1	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-084-69	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-084-69	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-083-58	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-083-58	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-082-48	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-082-48	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-081-39	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-081-39	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-080-33	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-080-33	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-079-24	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-079-24	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-15-078-13	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-15-078-13	UPDATE	Threshold maximum	TBD	N/A
06/19/2024	3.27.0	EXP-13-004-2	UPDATE	Category	Expenditures	N/A
06/19/2024	3.27.0	EXP-13-004-2	UPDATE	Ta min	0
06/19/2024	3.27.0	EXP-13-004-2	UPDATE	Ta max	0.1
02/26/2025	3.34.0	EXP-12-157-8	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-157-8	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-156-6	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-156-6	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-155-80	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-155-80	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-154-79	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-154-79	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-153-78	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-153-78	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-152-77	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-152-77	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-151-76	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-151-76	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-150-75	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-150-75	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-149-74	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-149-74	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-148-73	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-148-73	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-147-71	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-147-71	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-146-70	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-146-70	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-145-69	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-145-69	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-144-68	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-144-68	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-143-67	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-143-67	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-142-66	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-142-66	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-141-65	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-141-65	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-140-64	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-140-64	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-139-63	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-139-63	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-137-60	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-137-60	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-136-59	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-136-59	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-135-58	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-135-58	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-134-57	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-134-57	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-133-56	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-133-56	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-132-55	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-132-55	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-131-54	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-131-54	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-130-53	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-130-53	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-129-52	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-129-52	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-128-50	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-128-50	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-127-49	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-127-49	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-126-48	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-126-48	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-125-47	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-125-47	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-124-46	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-124-46	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-123-45	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-123-45	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-122-44	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-122-44	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-121-43	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-121-43	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-120-41	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-120-41	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-119-40	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-119-40	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-118-39	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-118-39	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-117-38	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-117-38	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-116-37	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-116-37	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-115-35	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-115-35	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-114-34	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-114-34	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-113-33	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-113-33	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-112-32	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-112-32	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-111-31	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-111-31	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-110-30	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-110-30	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-109-29	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-109-29	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-108-28	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-108-28	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-107-26	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-107-26	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-106-25	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-106-25	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-105-24	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-105-24	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-104-23	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-104-23	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-103-22	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-103-22	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-102-21	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-102-21	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-101-20	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-101-20	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-100-19	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-100-19	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-099-18	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-099-18	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-098-17	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-098-17	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-097-15	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-097-15	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-096-14	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-096-14	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-095-13	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-095-13	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-094-12	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-094-12	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-092-10	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-092-10	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-091-9	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-091-9	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-090-7	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-090-7	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-089-5	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-089-5	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-088-4	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-088-4	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-087-72	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-087-72	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-086-61	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-086-61	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-085-51	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-085-51	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-084-42	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-084-42	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-083-36	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-083-36	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-082-27	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-082-27	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-081-16	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-081-16	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-12-080-3	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-12-080-3	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-159-10	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-159-10	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-158-8	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-158-8	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-157-82	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-157-82	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-156-81	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-156-81	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-155-80	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-155-80	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-154-79	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-154-79	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-153-78	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-153-78	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-152-77	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-152-77	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-151-76	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-151-76	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-150-75	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-150-75	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-149-73	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-149-73	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-148-72	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-148-72	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-147-71	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-147-71	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-146-70	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-146-70	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-145-69	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-145-69	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-144-68	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-144-68	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-143-67	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-143-67	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-142-66	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-142-66	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-141-65	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-141-65	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-139-62	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-139-62	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-138-61	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-138-61	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-137-60	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-137-60	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-136-59	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-136-59	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-135-58	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-135-58	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-134-57	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-134-57	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-133-56	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-133-56	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-132-55	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-132-55	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-131-54	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-131-54	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-130-52	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-130-52	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-129-51	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-129-51	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-128-50	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-128-50	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-127-49	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-127-49	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-126-48	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-126-48	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-125-47	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-125-47	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-124-46	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-124-46	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-123-45	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-123-45	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-122-43	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-122-43	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-121-42	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-121-42	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-120-41	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-120-41	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-119-40	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-119-40	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-118-39	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-118-39	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-117-37	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-117-37	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-116-36	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-116-36	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-115-35	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-115-35	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-114-34	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-114-34	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-113-33	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-113-33	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-112-32	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-112-32	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-111-31	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-111-31	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-110-30	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-110-30	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-109-28	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-109-28	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-108-27	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-108-27	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-107-26	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-107-26	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-106-25	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-106-25	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-105-24	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-105-24	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-104-23	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-104-23	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-103-22	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-103-22	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-102-21	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-102-21	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-101-20	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-101-20	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-100-19	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-100-19	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-099-17	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-099-17	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-098-16	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-098-16	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-097-15	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-097-15	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-096-14	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-096-14	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-094-12	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-094-12	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-093-11	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-093-11	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-092-9	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-092-9	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-091-7	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-091-7	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-090-6	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-090-6	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-089-74	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-089-74	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-088-63	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-088-63	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-087-53	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-087-53	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-086-44	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-086-44	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-085-38	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-085-38	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-084-29	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-084-29	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-11-083-18	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-11-083-18	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-1-022-13	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-1-022-13	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-1-021-12	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-1-021-12	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-1-020-11	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-1-020-11	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-1-019-10	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-1-019-10	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-1-018-9	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-1-018-9	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-1-017-8	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-1-017-8	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-1-016-7	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-1-016-7	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-1-015-6	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-1-015-6	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-1-014-5	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-1-014-5	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-10-025-1	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-10-025-1	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-10-024-8	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-10-024-8	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-10-023-7	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-10-023-7	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-10-022-6	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-10-022-6	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-10-021-5	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-10-021-5	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-10-020-4	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-10-020-4	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-10-019-3	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-10-019-3	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-10-018-2	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-10-018-2	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-10-017-9	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-10-017-9	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-10-016-16	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-10-016-16	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-10-015-15	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-10-015-15	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-10-014-14	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-10-014-14	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-10-013-13	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-10-013-13	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-10-012-12	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-10-012-12	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-10-011-11	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-10-011-11	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-10-010-10	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-10-010-10	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EXP-10-009-17	UPDATE	Threshold minimum	TBD	N/A
02/26/2025	3.34.0	EXP-10-009-17	UPDATE	Threshold maximum	TBD	N/A
02/26/2025	3.34.0	EL-6-019-19	UPDATE	Annotation	N/A	Count the number of 'Other - specific CMS approval duals'
02/26/2025	3.34.0	EL-6-019-19	UPDATE	Specification	N/A	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Count of number of 'Other - specific CMS approval duals'Of the MSIS IDs which meet the criteria from STEP 2, count the number with 1. DUAL-ELIGIBLE-CODE = '09'
02/26/2025	3.34.0	EL-6-017-17	UPDATE	Annotation	N/A	Count the number of 'QI-1 Duals'
02/26/2025	3.34.0	EL-6-017-17	UPDATE	Specification	N/A	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Count of number of 'QI-1 Duals'Of the MSIS IDs which meet the criteria from STEP 2, count the number with 1. DUAL-ELIGIBLE-CODE = '06'
02/26/2025	3.34.0	EL-6-016-16	UPDATE	Annotation	N/A	Count the number of 'QDWI Duals'
02/26/2025	3.34.0	EL-6-016-16	UPDATE	Specification	N/A	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Count of number of 'QDWI Duals'Of the MSIS IDs which meet the criteria from STEP 2, count the number with 1. DUAL-ELIGIBLE-CODE = '05'
02/26/2025	3.34.0	EL-6-015-15	UPDATE	Annotation	N/A	Count the number of 'SLMB Plus Duals'
02/26/2025	3.34.0	EL-6-015-15	UPDATE	Specification	N/A	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Count of number of 'SLMB Plus Duals'Of the MSIS IDs which meet the criteria from STEP 2, count the number with 1. DUAL-ELIGIBLE-CODE = '04'
02/26/2025	3.34.0	EL-6-014-14	UPDATE	Annotation	N/A	Count the number of 'SLMB Only Duals'
02/26/2025	3.34.0	EL-6-014-14	UPDATE	Specification	N/A	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Count of number of 'SLMB Only Duals'Of the MSIS IDs which meet the criteria from STEP 2, count the number with 1. DUAL-ELIGIBLE-CODE = '03'
02/26/2025	3.34.0	EL-6-013-13	UPDATE	Annotation	N/A	Count the number of 'QMB Plus Duals'
02/26/2025	3.34.0	EL-6-013-13	UPDATE	Specification	N/A	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Count of number of 'QMB Plus Duals'Of the MSIS IDs which meet the criteria from STEP 2, count the number with 1. DUAL-ELIGIBLE-CODE = '02'
02/26/2025	3.34.0	EL-6-012-12	UPDATE	Annotation	N/A	Count the number of 'QMB Only Duals'
02/26/2025	3.34.0	EL-6-012-12	UPDATE	Specification	N/A	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Count of number of 'QMB Only Duals'Of the MSIS IDs which meet the criteria from STEP 2, count the number with 1. DUAL-ELIGIBLE-CODE = '01'
06/19/2024	3.27.0	EL-5-001-3	UPDATE	Longitudinal threshold	TBD	N/A
06/19/2024	3.27.0	EL-3-002-7	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	EL-3-002-7	UPDATE	Category	Beneficiary eligibility	N/A
06/19/2024	3.27.0	EL-3-002-7	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	EL-3-002-7	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	EL-3-002-7	UPDATE	Ta min	0.95
06/19/2024	3.27.0	EL-3-002-7	UPDATE	Ta max	1
06/19/2024	3.27.0	EL-3-002-7	UPDATE	Annotation	Calculate the percentage of eligibles in ELIGIBILITY-GROUP QMB, QDWI, SLMB or QI (23 through 26) with valid DUAL-ELIGIBLE CODE 01 through 10	N/A
06/19/2024	3.27.0	EL-3-002-7	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month 3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Eligibility Group: QMB, QDWI, SLMB or QIOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with ELIGIBLE-GROUP=“23” or “24” or “25” or “26” STEP 4: Dual eligibleOf the MSIS IDs that meet the criteria from STEP 3, further refine the population by keeping records with DUAL-ELIGIBLE-CODE=“01” or “02” or “03” or “04” or “05” or “06” or “08” or “09” or “10” STEP 5: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 4 by the count of MSIS IDs from STEP 3	N/A
11/15/2023	3.16.0	EL-3-001-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Unique Valid CodesOf the MSIS IDs that meet the criteria from STEP 2, select those with a valid value for ELIGIBILITY-GROUP:1. ELIGIBILITY-GROUP = "1" or "2" or "3" or "4" or "5" or "6" or "7" or "8" or "9" or "72" or "73" or "74" or "75" or "11" or "12" or "13" or "14" or "15" or "16" or "17" or "18" or "19" or "20" or "21" or "22" or "23" or "24" or "25" or "26" or "27" or "28" or "29" or "30" or "31" or "32" or "33" or "34" or "35" or "36" or "37" or "38" or "39" or "40" or "41" or "42" or "43" or "44" or "45" or "46" or "47" or "48" or "49" or "50" or "51" or "52" or "53" or "54" or "55" or "56" or "59" or "60" or "61" or "62" or "63" or "64" or "65" or "66" or "67" or "68" or "69" or "70" or "71" or "76"2. Remove any duplicates, so each MSIS ID only appears once.	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Unique Valid CodesOf the MSIS IDs that meet the criteria from STEP 2, select those with a valid value for ELIGIBILITY-GROUP:1. ELIGIBILITY-GROUP = "01" or "02" or "03" or "04" or "05" or "06" or "07" or "08" or "09" or "72" or "73" or "74" or "75" or "11" or "12" or "13" or "14" or "15" or "16" or "17" or "18" or "19" or "20" or "21" or "22" or "23" or "24" or "25" or "26" or "27" or "28" or "29" or "30" or "31" or "32" or "33" or "34" or "35" or "36" or "37" or "38" or "39" or "40" or "41" or "42" or "43" or "44" or "45" or "46" or "47" or "48" or "49" or "50" or "51" or "52" or "53" or "54" or "55" or "56" or "59" or "60" or "61" or "62" or "63" or "64" or "65" or "66" or "67" or "68" or "69" or "70" or "71" or "76"2. Remove any duplicates, so each MSIS ID only appears once.
06/19/2024	3.27.0	EL-2-001-1	UPDATE	Longitudinal threshold	TBD	N/A
06/19/2024	3.27.0	EL-1-009-8	UPDATE	Longitudinal threshold	TBD	N/A
06/19/2024	3.27.0	EL-1-008-7	UPDATE	Longitudinal threshold	TBD	N/A
06/19/2024	3.27.0	EL-1-007-5	UPDATE	Longitudinal threshold	TBD	N/A
06/19/2024	3.27.0	EL-1-006-4	UPDATE	Longitudinal threshold	TBD	N/A
11/15/2023	3.16.0	EL-1-001-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Non-missing SSNOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with non-missing SSNSTEP 4: Non-missing MSIS IDOf the MSIS IDs that meet the criteria from STEP 3, further refine the population by keeping records with non-missing MSIS-IDENTIFICATION-NUMSTEP 5: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 4 by the count of MSIS IDs from STEP 1	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHICS-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Non-missing SSNOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with non-missing SSNSTEP 4: Non-missing MSIS IDOf the MSIS IDs that meet the criteria from STEP 3, further refine the population by keeping records with non-missing MSIS-IDENTIFICATION-NUMSTEP 5: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 4 by the count of MSIS IDs from STEP 1
03/27/2024	3.22.0	EL-10-004-5	UPDATE	Measure name	% of MSIS IDs with restricted benefit (RESTRICTED-BENEFITS-CODE = 02 through 06) enrolled in comprehensive managed care (MANAGED-CARE-PLAN-TYPE = 01)	% of MSIS IDs with restricted benefit (RESTRICTED-BENEFITS-CODE = 02, 03, or 06) enrolled in comprehensive managed care (MANAGED-CARE-PLAN-TYPE = 01)
03/27/2024	3.22.0	EL-10-004-5	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Restricted benefit eligiblesOf the MSIS IDs that meet the criteria from STEP 2, further refine the population using RESTRICTED-BENEFITS-CODE = (“2” or “3” or “4” or “5” or “6”)STEP 4: Managed care enrollment on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 5: Identify individuals in a comprehensive managed care planSelect MSIS IDs from STEP 4 where MANAGED-CARE-PLAN-TYPE = "01"STEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Restricted benefit eligiblesOf the MSIS IDs that meet the criteria from STEP 2, further refine the population using RESTRICTED-BENEFITS-CODE = (“2” or “3” or “6”)STEP 4: Managed care enrollment on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 5: Identify individuals in a comprehensive managed care planSelect MSIS IDs from STEP 4 where MANAGED-CARE-PLAN-TYPE = "01"STEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3
06/19/2024	3.27.0	EL-10-001-1	UPDATE	Longitudinal threshold	TBD	N/A
11/15/2023	3.16.0	ALL-2-003-3	UPDATE	Specification	STEP 1: STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: 1915(i) eligiblesOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '02'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 5STEP 7: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 6 by the number of MSIS-IDs from STEP 3	STEP 1: STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: 1915(i) eligiblesOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '02'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 5STEP 7: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 6 by the number of MSIS-IDs from STEP 3
11/15/2023	3.16.0	ALL-2-002-2	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: Community First ChoiceOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '01'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 5STEP 7: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 6 by the number of MSIS-IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: State plan participation on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment STATE-PLAN-OPTION-PARTICIPATION-ELG00011 by keeping records that satisfy the following criteria:1a. STATE-PLAN-OPTION-EFF-DATE <= last day of the DQ report month2a. STATE-PLAN-OPTION-END-DATE >= last day of the DQ report month OR missingOR1b. STATE-PLAN-OPTION-EFF-DATE is missing2b. STATE-PLAN-OPTION-END-DATE is missingSTEP 3: Community First ChoiceOf the MSIS-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:STATE-PLAN-OPTION-TYPE = '01'STEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid FFS and Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3" 2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 6: Eligibles with OT claimsOf the MSIS-IDs from STEP 3, count the number which also appear in the claims from STEP 5STEP 7: Calculate percentage for measureDivide the number of MSIS-IDs from STEP 6 by the number of MSIS-IDs from STEP 3
09/12/2024	3.29.0	TPL.006.085	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	TPL.006.084	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	TPL.005.069	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	TPL.005.068	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']6. Value must occur on or before individual's Date of Death (ELG.002.025) when populated	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]6. Value must occur on or before individual's Date of Death (ELG.002.025) when populated
09/12/2024	3.29.0	TPL.005.066	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual (except on service tracking payments). Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique "key" value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47572	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual (except on service tracking payments). Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, 'CMS Guidance: Reporting Shared MSIS Identification Numbers' for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47572
09/12/2024	3.29.0	TPL.004.060	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	TPL.004.059	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	TPL.004.058	UPDATE	Coding requirement	1. Value must be in Coverage Type List (VVL).2. Value must be 2 characters3. Mandatory	1. Value must be in Coverage Type List (VVL)2. Value must be 2 characters3. Mandatory
09/12/2024	3.29.0	TPL.003.049	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']6. When associated Date of Death (ELG.002.025) is populated, data element value must be less than or equal to Date of Death	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]6. When associated Date of Death (ELG.002.025) is populated, data element value must be less than or equal to Date of Death
09/12/2024	3.29.0	TPL.003.048	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	TPL.003.038	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	TPL.003.089	UPDATE	Coding requirement	1. Value must be in Coverage Type List (VVL).2. Value must be 2 characters3. Mandatory	1. Value must be in Coverage Type List (VVL)2. Value must be 2 characters3. Mandatory
09/12/2024	3.29.0	TPL.003.032	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual (except on service tracking payments). Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique "key" value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47572	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual (except on service tracking payments). Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, 'CMS Guidance: Reporting Shared MSIS Identification Numbers' for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47572
09/12/2024	3.29.0	TPL.002.026	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	TPL.002.025	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']6. Value must be equal to or less than the individual's Date of Death (ELG.002.025)	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]6. Value must be equal to or less than the individual's Date of Death (ELG.002.025)
09/12/2024	3.29.0	TPL.002.020	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in TPL Health Insurance Coverage Indicator List (VVL)4. Mandatory5. When value equals '1', there must be one corresponding TPL Medicaid Eligible Person Health Insurance Coverage Information (TPL.003) segment with the same MSIS ID.	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in TPL Health Insurance Coverage Indicator List (VVL)4. Mandatory5. When value equals "1", there must be one corresponding TPL Medicaid Eligible Person Health Insurance Coverage Information (TPL.003) segment with the same MSIS ID.
09/12/2024	3.29.0	TPL.002.019	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual (except on service tracking payments). Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique "key" value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47572	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual (except on service tracking payments). Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, 'CMS Guidance: Reporting Shared MSIS Identification Numbers' for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47572
09/12/2024	3.29.0	TPL.001.011	UPDATE	Coding requirement	1. For production files, value must be equal to 'P'2. Value must be in File Status Indicator List (VVL)3. Value must be 1 character4. Mandatory	1. For production files, value must be equal to "P"2. Value must be in File Status Indicator List (VVL)3. Value must be 1 character4. Mandatory
09/12/2024	3.29.0	TPL.001.007	UPDATE	Coding requirement	1. Value must be in State Code List (VVL)2. Value must be 2 characters3. Mandatory4. Value must be the same for all records	1. Value must be in State Code List (VVL)2. Value must be 2 characters3. Mandatory
09/12/2024	3.29.0	TPL.001.006	UPDATE	Coding requirement	1. Value must equal 'TPL-FILE'2. Mandatory	1. Value must equal "TPL-FILE"2. Mandatory
09/12/2024	3.29.0	PRV.010.131	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in[18,19,20,99]
09/12/2024	3.29.0	PRV.010.130	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	PRV.009.122	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	PRV.009.121	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	PRV.008.112	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	PRV.008.111	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	PRV.007.099	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	PRV.007.098	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	PRV.006.091	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	PRV.006.090	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	PRV.006.089	UPDATE	Coding requirement	1. If associated Provider Classification Type equals 1, value must be in Provider Taxonomy List (VVL)2. If associated Provider Classification Type equals 2, value must be in Provider Specialty List (VVL)3. If associated Provider Classification Type equals 3, value must be in Provider Type Code List (VVL)4. If associated Provider Classification Type equals 4, value must be in Provider Authorized Category of Service Code List (VVL)5. Value must be 20 characters or less6. Mandatory	1. If associated Provider Classification Type equals "1", value must be in Provider Taxonomy List (VVL)2. If associated Provider Classification Type equals 2, value must be in Provider Specialty List (VVL)3. If associated Provider Classification Type equals "3", value must be in Provider Type Code List (VVL)4. If associated Provider Classification Type equals "4", value must be in Provider Authorized Category of Service Code List (VVL)5. Value must be 20 characters or less6. Mandatory
09/12/2024	3.29.0	PRV.006.088	UPDATE	Definition	A code to identify the schema used in the Provider Classification Code field to categorize providers. See T-MSIS Guidance Document, "CMS Guidance: Best Practice for Reporting Provider Classification Type and Provider Classification Code in the T-MSIS Provider File" https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/98581 . A provider may be reported with multiple active record segments with the same Provider Classification Type if different Provider Classification Code values apply.	A code to identify the schema used in the Provider Classification Code field to categorize providers. See T-MSIS Guidance Document, 'CMS Guidance: Best Practice for Reporting Provider Classification Type and Provider Classification Code in the T-MSIS Provider File' https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/98581 . A provider may be reported with multiple active record segments with the same Provider Classification Type if different Provider Classification Code values apply.
09/12/2024	3.29.0	PRV.005.080	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	PRV.005.079	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	PRV.005.078	UPDATE	Coding requirement	1. Value must not contain a pipe or asterisk symbol2. (State-specific Medicaid Provider) if associated Provider Identifier Type (PRV.005.077) value is equal to 1, then value must equal (PRV.005.073) Submitting State3. (NPI) if associated Provider Identifier Type (PRV.005.077) value is equal to 2, then value must equal 'NPI'4. (Medicare) if associated Provider Identifier Type (PRV.005.077) value is equal to 3, then value must equal 'CMS'5. (NCPDP) if associated Provider Identifier Type (PRV.005.077) value is equal to 4, then value must equal 'NCPDP'6. (Federal Tax ID) if associated Provider Identifier Type (PRV.005.077) value is equal to 5, then value must equal 'IRS'7. (SSN) if associated Provider Identifier Type (PRV.005.077) value is equal to 7, then value must be equal to 'SSA'8. Value must be 18 characters or less9. Mandatory	1. Value must not contain a pipe or asterisk symbol2. (State-specific Medicaid Provider) if associated Provider Identifier Type (PRV.005.077) value is equal to 1, then value must equal (PRV.005.073) Submitting State3. (NPI) if associated Provider Identifier Type (PRV.005.077) value is equal to "2", then value must equal "NPI"4. (Medicare) if associated Provider Identifier Type (PRV.005.077) value is equal to "3", then value must equal "CMS"5. (NCPDP) if associated Provider Identifier Type (PRV.005.077) value is equal to "4", then value must equal "NCPDP"6. (Federal Tax ID) if associated Provider Identifier Type (PRV.005.077) value is equal to "5", then value must equal "IRS"7. (SSN) if associated Provider Identifier Type (PRV.005.077) value is equal to "7", then value must be equal to "SSA"8. Value must be 18 characters or less9. Mandatory
09/12/2024	3.29.0	PRV.005.077	UPDATE	Coding requirement	1. Value must be in Provider Identifier Type List (VVL)2. Mandatory3. Value must be 1 character4. When value equals '2', the associated Provider Identifier (PRV.005.081) must be a valid NPI	1. Value must be in Provider Identifier Type List (VVL)2. Mandatory3. Value must be 1 character4. When value equals "2", the associated Provider Identifier (PRV.005.081) must be a valid NPI
09/12/2024	3.29.0	PRV.004.068	UPDATE	Coding requirement	1. Value must not contain a pipe or asterisk symbol2. Value must be 60 characters or less3. (required) if associated License or Accreditation Number (PRV.004.069) value is populated, then value is mandatory and must be provided4. Mandatory5. Value must equal 'DEA' when associated License Type equals '2'	1. Value must not contain a pipe or asterisk symbol2. Value must be 60 characters or less3. (required) if associated License or Accreditation Number (PRV.004.069) value is populated, then value is mandatory and must be provided4. Mandatory5. Value must equal "DEA" when associated License Type equals "2"
09/12/2024	3.29.0	PRV.004.066	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	PRV.004.065	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	PRV.003.054	UPDATE	Coding requirement	1. Must contain the '@' symbol2. May contain uppercase and lowercase Latin letters A to Z and a to z3. May contain digits 0-94. Must contain a dot '.' that is not the first or last character and provided that it does not appear consecutively5. Value must be 60 characters or less6. Situational	1. Must contain the "@" symbol2. May contain uppercase and lowercase Latin letters A to Z and a to z3. May contain digits 0-94. Must contain a dot "." that is not the first or last character and provided that it does not appear consecutively5. Value must be 60 characters or less6. Situational
09/12/2024	3.29.0	PRV.003.045	UPDATE	Data element name text	Provider Location & Contact Info End Date	Provider Location Contact Info End Date
09/12/2024	3.29.0	PRV.003.045	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	PRV.003.044	UPDATE	Data element name text	Provider Location & Contact Info Effective Date	Provider Location Contact Info Effective Date
09/12/2024	3.29.0	PRV.003.044	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	PRV.002.032	UPDATE	Coding requirement	1. Value must be in Ownership Code List (VVL)2. Value must be 2 characters3. Conditional4. Value is mandatory when associated Facility Group Individual Code (PRV.002.026) is in ['01, '02'] (organization)	1. Value must be in Ownership Code List (VVL)2. Value must be 2 characters3. Conditional4. Value is mandatory when associated Facility Group Individual Code (PRV.002.026) is in [01,02] (organization)
02/20/2025	3.34.0	PRV.002.031	UPDATE	Definition	Either individual's biological sex or their self-identified sex.	The individual's biological sex assigned at birth.
09/12/2024	3.29.0	PRV.002.027	UPDATE	Coding requirement	1. Value must be in Teaching Indicator List (VVL)2. Value must be 1 character3. Value must be '0' when Facility Group Individual Code (PRV.002.026) equals '02' or '03'4. Conditional	1. Value must be in Teaching Indicator List (VVL)2. Value must be 1 character3. Value must be "0" when Facility Group Individual Code (PRV.002.026) in [02,03]4. Conditional
09/12/2024	3.29.0	PRV.002.026	UPDATE	Coding requirement	1. Value must be in Facility Group Individual Code List (VVL)2. Value must be 2 characters3. Mandatory4. (individual) if value equals '03', then Provider First Name (PRV.002.028) must be populated5. (organization) if value does not equal '03', then Provider Middle Initial (PRV.002.029) must not be populated6. (individual) if value equals '03', then Provider Last Name (PRV.002.030) must be populated7. (individual) if value equals '03', then Provider Sex (PRV.002.031) must be populated8. (individual) if value equals '03', then Provider Date of Birth (PRV.002.034) must be populated9. (organization) if value equals '01' or '02', then Provider Date of Death (PRV.002.035) must not be populated10. (individual) if value equals '03', then there must be one Provider Identifier (PRV.005.081) populated with an associated Provider Identifier Type (PRV.005.077) equal to ‘2’ (NPI)	1. Value must be in Facility Group Individual Code List (VVL)2. Value must be 2 characters3. Mandatory4. (individual) if value equals "03", then Provider First Name (PRV.002.028) must be populated5. (organization) if value does not equal "03", then Provider Middle Initial (PRV.002.029) must not be populated6. (individual) if value equals "03", then Provider Last Name (PRV.002.030) must be populated7. (individual) if value equals "03", then Provider Sex (PRV.002.031) must be populated8. (individual) if value equals "03", then Provider Date of Birth (PRV.002.034) must be populated9. (organization) if value is in [01,02], then Provider Date of Death (PRV.002.035) must not be populated10. (individual) if value equals "03", then there must be one Provider Identifier (PRV.005.081) populated with an associated Provider Identifier Type (PRV.005.077) equal to "2" (NPI)
09/12/2024	3.29.0	PRV.002.021	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	PRV.002.020	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	PRV.001.011	UPDATE	Coding requirement	1. For production files, value must be equal to 'P'2. Value must be in File Status Indicator List (VVL)3. Value must be 1 character4. Mandatory	1. For production files, value must be equal to "P"2. Value must be in File Status Indicator List (VVL)3. Value must be 1 character4. Mandatory
09/12/2024	3.29.0	PRV.001.007	UPDATE	Coding requirement	1. Value must be in State Code List (VVL)2. Value must be 2 characters3. Mandatory4. Value must be the same for all records	1. Value must be in State Code List (VVL)2. Value must be 2 characters3. Mandatory
09/12/2024	3.29.0	PRV.001.006	UPDATE	Coding requirement	1. Value must equal 'PROVIDER'2. Mandatory	1. Value must equal "PROVIDER"2. Mandatory
09/12/2024	3.29.0	MCR.007.088	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	MCR.007.087	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	MCR.006.079	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19, 20, 99]
09/12/2024	3.29.0	MCR.006.078	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19, 20]
09/12/2024	3.29.0	MCR.005.070	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	MCR.005.069	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	MCR.005.067	UPDATE	Coding requirement	1. Value must be in Operating Authority List (VVL)2. Value must be 2 characters or less3. Mandatory	1. Value must be in Operating Authority List (VVL)2. Value must be 2 characters3. Mandatory
09/12/2024	3.29.0	MCR.004.060	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	MCR.004.059	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	MCR.004.058	UPDATE	Coding requirement	1. Value must be in Managed Care Service Area Name List (VVL)2. If associated Managed Care Service Area (MCR.002.029) is in [ 2, 3, 4, 5, 6 ], then value is mandatory and must be provided3. Value must not contain a pipe or asterisk symbol4. Value must be 30 characters or less5. Conditional6. If associated Managed Care Service Area (MCR.002.029) equals '5' (zipcode), then value must be a 5-digit zipcode7. If associated Managed Care Service Area (MCR.002.029) equals '2' (county code), then value must be a 3-digit number	1. Value must be in Managed Care Service Area Name List (VVL)2. If associated Managed Care Service Area (MCR.002.029) is in [2,3,4,5,6], then value is mandatory and must be provided3. Value must not contain a pipe or asterisk symbol4. Value must be 30 characters or less5. Conditional6. If associated Managed Care Service Area (MCR.002.029) equals "5" (zipcode), then value must be a 5-digit zipcode7. If associated Managed Care Service Area (MCR.002.029) equals "2" (county code), then value must be a 3-digit number
09/12/2024	3.29.0	MCR.003.050	UPDATE	Coding requirement	1. Must contain the '@' symbol2. May contain uppercase and lowercase Latin letters A to Z and a to z3. May contain digits 0-94. Must contain a dot '.' that is not the first or last character and provided that it does not appear consecutively5. Value must be 60 characters or less6. Situational	1. Must contain the '@' symbol2. May contain uppercase and lowercase Latin letters A to Z and a to z3. May contain digits 0-94. Must contain a dot "." that is not the first or last character and provided that it does not appear consecutively5. Value must be 60 characters or less6. Situational
09/12/2024	3.29.0	MCR.003.044	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 (CE) or Address Line 2 (CE) value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Conditional
09/12/2024	3.29.0	MCR.003.040	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	MCR.003.039	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	MCR.003.038	UPDATE	Coding requirement	1. Value must not contain a pipe symbol2. Each managed care entity's locations must have a unique identifier3. Value must be populated if associated Managed Care Address Type (MCR.003.041) equals 3 (Managed care entity's service location address)4. Value must be 15 characters or less5. Mandatory	1. Value must not contain a pipe symbol2. Each managed care entity's locations must have a unique identifier3. Value must be populated if associated Managed Care Address Type (MCR.003.041) equals "3" (Managed care entity's service location address)4. Value must be 15 characters or less5. Mandatory
09/12/2024	3.29.0	MCR.002.031	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	MCR.002.030	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	MCR.002.029	UPDATE	Coding requirement	1. Value must be in Managed Care Service Area List (VVL)2. Value must be 1 character3. Mandatory4. When value equals '2', the associated Managed Care Service Area Name (MCR.004.058) value must be a valid US County Code	1. Value must be in Managed Care Service Area List (VVL)2. Value must be 1 character3. Mandatory4. When value equals "2", the associated Managed Care Service Area Name (MCR.004.058) value must be a valid US County Code
09/12/2024	3.29.0	MCR.002.020	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']6. Mandatory7. Value must occur before Managed Care Contract End Date (MCR.002.021)	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]6. Mandatory7. Value must occur before Managed Care Contract End Date (MCR.002.021)
09/12/2024	3.29.0	MCR.001.011	UPDATE	Coding requirement	1. For production files, value must be equal to 'P'2. Value must be in File Status Indicator List (VVL)3. Value must be 1 character4. Mandatory	1. For production files, value must be equal to "P"2. Value must be in File Status Indicator List (VVL)3. Value must be 1 character4. Mandatory
09/12/2024	3.29.0	MCR.001.007	UPDATE	Coding requirement	1. Value must be in State Code List (VVL)2. Value must be 2 characters3. Mandatory4. Value must be the same for all records	1. Value must be in State Code List (VVL)2. Value must be 2 characters3. Mandatory
09/12/2024	3.29.0	MCR.001.006	UPDATE	Coding requirement	1. Value must equal 'MNGDCARE'2. Mandatory	1. Value must equal "MNGDCARE"2. Mandatory
09/12/2024	3.29.0	ELG.022.266	UPDATE	Definition	A code to identify the reason for changing the MSIS Identification Number of a beneficiary and only required for Eligibile Identifier Type = '2-Old MSIS Identification Number'. For example, If MSIS Identification Number of a beneficiary is being changed due to 'Merge with other MSIS ID' or 'Unmerge'.	A code to identify the reason for changing the MSIS Identification Number of a beneficiary and only required for Eligibile Identifier Type = "2-Old MSIS Identification Number". For example, If MSIS Identification Number of a beneficiary is being changed due to "Merge with other MSIS ID" or "Unmerge".
09/12/2024	3.29.0	ELG.022.266	UPDATE	Coding requirement	1. Value must be in Reason for Change List (VVL)2. Value must be 10 characters or less3. Conditional4. (Old MSIS Identification Number) value must be populated when Eligible Identifier Type (ELG.022.261) equals '2'	1. Value must be in Reason for Change List (VVL)2. Value must be 10 characters or less3. Conditional4. (Old MSIS Identification Number) value must be populated when Eligible Identifier Type (ELG.022.261) equals "2"
09/12/2024	3.29.0	ELG.022.265	UPDATE	Definition	A data element to capture the various identifiers assigned to Medicaid and CHIP beneficiary by various entities. The specific type of identifier is shown in the corresponding value in the Eligible Identifier Type data element. States should provide all Old MSIS Identification Number with Eligible Identifier Type = 2 to T-MSIS in case the state changes the MSIS Identification Number of a beneficiary. The state should submit updates to T-MSIS whenever an identifier is retired or issued. States should provide Old MSIS Identification Number with Reason for Change = 'MERGE' to T-MSIS if the state was reporting multiple MSIS Identification Numbers for a single beneficiary and merges them under a single MSIS Identification Number. States should provide Old MSIS Identification Number with Reason for Change = 'UNMERGE' to T-MSIS if the state unmerges a beneficiary from another beneficiary. For example, if a newborn child is originally reported with the mother's MSIS Identification Number and is then assigned a different MSIS Identification Number. States should provide Old MSIS Identification Number with Reason for Change = 'LSE' to T-MSIS if the state assigns a new MSIS Identification Number to any beneficiaries during large system enhancement in state MMIS. States should provide Old MSIS Identification Number with Reason for Change = 'TCAM' to T-MSIS if the Medicaid and Separate CHIP programs use different MSIS Identifier Number schemas and beneficiaries are transferred from CHIP to Medicaid or from Medicaid to CHIP and a new MSIS Identification Number is issued.	A data element to capture the various identifiers assigned to Medicaid and CHIP beneficiary by various entities. The specific type of identifier is shown in the corresponding value in the Eligible Identifier Type data element. States should provide all Old MSIS Identification Number with Eligible Identifier Type = "2" to T-MSIS in case the state changes the MSIS Identification Number of a beneficiary. The state should submit updates to T-MSIS whenever an identifier is retired or issued. States should provide Old MSIS Identification Number with Reason for Change = "MERGE" to T-MSIS if the state was reporting multiple MSIS Identification Numbers for a single beneficiary and merges them under a single MSIS Identification Number. States should provide Old MSIS Identification Number with Reason for Change = "UNMERGE" to T-MSIS if the state unmerges a beneficiary from another beneficiary. For example, if a newborn child is originally reported with the mother's MSIS Identification Number and is then assigned a different MSIS Identification Number. States should provide Old MSIS Identification Number with Reason for Change = "LSE" to T-MSIS if the state assigns a new MSIS Identification Number to any beneficiaries during large system enhancement in state MMIS. States should provide Old MSIS Identification Number with Reason for Change = "TCAM" to T-MSIS if the Medicaid and Separate CHIP programs use different MSIS Identifier Number schemas and beneficiaries are transferred from CHIP to Medicaid or from Medicaid to CHIP and a new MSIS Identification Number is issued.
09/12/2024	3.29.0	ELG.022.264	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.022.263	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.022.262	UPDATE	Coding requirement	Value must be 18 characters or less	1. Value must be 18 characters or less
09/12/2024	3.29.0	ELG.022.260	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual (except on service tracking payments). Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique "key" value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47572	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual (except on service tracking payments). Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, 'CMS Guidance: Reporting Shared MSIS Identification Numbers' for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47572
09/12/2024	3.29.0	ELG.021.254	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.021.253	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.021.252	UPDATE	Coding requirement	1. Value must be in Enrollment Type List (VVL)2. Value must be 1 character3. If value equals 1, then associated CHIP Code (ELG.003.054) value must be in [1, 2]4. If value equals 2, then associated CHIP Code (ELG.003.054) value must be "3"5. A person enrolled in Medicaid/CHIP must have a primary eligibility group classification for any given day of enrollment. (There may or may not be a secondary eligibility group classification for that same day.)6. Mandatory	1. Value must be in Enrollment Type List (VVL)2. Value must be 1 character3. If value equals "1", then associated CHIP Code (ELG.003.054) value must be in [1,2]4. If value equals "2", then associated CHIP Code (ELG.003.054) value must be "3"5. A person enrolled in Medicaid/CHIP must have a primary eligibility group classification for any given day of enrollment. (There may or may not be a secondary eligibility group classification for that same day).6. Mandatory
09/12/2024	3.29.0	ELG.020.244	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.020.243	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.018.235	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.018.234	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.018.233	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	ELG.017.226	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.017.225	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.016.217	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.016.216	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.016.215	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in American Indian Alaskan Native Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in American Indian Alaskan Native Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	ELG.016.214	UPDATE	Coding requirement	1. If associated Race (ELG.016.213) value is in [ "010", "015" ], then value must be populated.2. Value must not contain a pipe or asterisk symbol3. Value must be 25 characters or less4. Conditional	1. If associated Race (ELG.016.213) value is in [010,015,018], then value must be populated.2. Value must not contain a pipe or asterisk symbol3. Value must be 25 characters or less4. Conditional
09/12/2024	3.29.0	ELG.015.271	UPDATE	Coding requirement	1. Value must be 25 characters or less2. If associated Ethnicity Code (ELG.015.204) is in ["4"], then value must be populated. 3. Conditional	1. Value must be 25 characters or less2. If associated Ethnicity Code (ELG.015.204) is in ["4"], then value must be populated.3. Conditional
09/12/2024	3.29.0	ELG.015.206	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.015.205	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.015.204	UPDATE	Definition	A code indicating that the individual's ethnicity is Hispanic, Latino/a, or Spanish ethnicity of a Medicaid/CHIP enrolled individual.. Ethnicity Code clarifications: If state has beneficiaries coded in their database as "Hispanic" or "Latino," then code them in T-MSIS as "Hispanic or Latino Unknown" (valid value "5"). DO NOT USE "Another Hispanic, Latino, or Spanish Origin," "Ethnicity Unknown" or "Ethnicity Unspecified." NOTE 1: The "Ethnicity Unspecified" category in T-MSIS (valid value "6") should be used with an individual who explicitly did not provide information or refused to answer a question.	A code indicating that the individual's ethnicity is Hispanic, Latino/a, or Spanish ethnicity of a Medicaid/CHIP enrolled individual. Ethnicity Code clarifications: If state has beneficiaries coded in their database as "Hispanic" or "Latino," then code them in T-MSIS as "Hispanic or Latino Unknown" (valid value "5"). DO NOT USE "Another Hispanic, Latino, or Spanish Origin," "Ethnicity Unknown" or "Ethnicity Unspecified." NOTE 1: The "Ethnicity Unspecified" category in T-MSIS (valid value "6") should be used with an individual who explicitly did not provide information or refused to answer a question.
09/12/2024	3.29.0	ELG.014.197	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.014.196	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.013.185	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.013.184	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.012.175	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.012.174	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.012.172	UPDATE	Coding requirement	1. Value must have a corresponding value in Waiver Type (ELG.012.173)2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by a version number [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Mandatory	1. Value must have a corresponding value in Waiver Type (ELG.012.173)2. Value must be 20 characters or less3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be "01" or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Mandatory
09/12/2024	3.29.0	ELG.011.165	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.011.164	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.011.163	UPDATE	Coding requirement	1. Value must be in State Plan Option Type List (VVL)2. If associated Eligibility Group (ELG.005.087) value is in [ "72", "73", "74", "75" ], and Restricted Benefits Code (ELG.DE.097) is "1" or "7", then value must be "06"3. Value must be 2 characters4. Mandatory5. Value must equal '02' when Program Type (CIP.002.129) equals '13'6. Value must equal '02' when Program Type (COT.002.065) equals '13'	1. Value must be in State Plan Option Type List (VVL)2. If associated Eligibility Group (ELG.005.087) value is in [ "72", "73", "74", "75" ], and Restricted Benefits Code (ELG.DE.097) is "1" or "7", then value must be "06"3. Value must be 2 characters4. Mandatory5. Value must equal "02" when Program Type (CIP.002.129) equals "13"6. Value must equal "02" when Program Type (COT.002.065) equals "13"
09/12/2024	3.29.0	ELG.011.159	UPDATE	Coding requirement	1. Mandatory2. Value must be 8 characters3. Value must be in Record ID List (VVL)4. Value must equal "ELG00011"	1. Mandatory3. Value must be in Record ID List (VVL)3. Value must be in Record ID List (VVL)4. Value must equal "ELG00011"
09/12/2024	3.29.0	ELG.010.156	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.010.155	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.010.153	UPDATE	Coding requirement	1. Value must be in MFP Reason Participation Ended List (VVL)2. Value must be 2 characters3. Conditional4. Value must not be populated when Enrollment End Date equals '9999-12-31'5. Value must be populated when Enrollment End Date does not equal '9999-12-31'	1. Value must be in MFP Reason Participation Ended List (VVL)2. Value must be 2 characters3. Conditional4. Value must not be populated when Enrollment End Date equals "9999-12-31"5. Value must be populated when Enrollment End Date does not equal "9999-12-31"
09/12/2024	3.29.0	ELG.009.270	UPDATE	Coding requirement	1. Value must be 3 characters2. Conditional3. Must be a 3 digit value from the Type-of-Service (VVL)	1. Value must be 3 characters2. Conditional3. Value must be in Type of Service List (VVL)
09/12/2024	3.29.0	ELG.009.143	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.009.142	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.008.133	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.008.132	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.007.122	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.007.121	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in[18,19,20]
09/12/2024	3.29.0	ELG.006.110	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.006.109	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.005.100	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.005.099	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.005.097	UPDATE	Coding requirement	1. Value must be in Restricted Benefits Code List (VVL)2. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "05", then Eligibility Group (ELG.005.087) must be "24"3. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "06", then Eligibility Group (ELG.005.087) must be "26"4. (Restricted Benefits) if value is "1" and Dual Eligible Code (ELG.005.085) value is "02", then Eligibility Group (ELG.005.087) must be "23"5. (Restricted Benefits) if value is "1" and Dual Eligible Code (ELG.005.085) value is "04", then Eligibility Group (ELG.005.087) must be "25"6. (Restricted Benefits) if value is "3", then Dual Eligible Code (ELG.005.085) cannot be "00"7. Mandatory8. If value is populated, then Eligibility Group (ELG.005.087) must be populated.9. If value is "6" then Eligibility Group(ELG.DE.087) must be in ("35", "70")10. If value is "1" or "7" then Eligibility Group (EGL.DE.087) must be in ("72", "73", "74", "75") and State Plan Option Type (ELG.DE.163) must equal to "06"11. (Restricted Pregnancy-Related) if value is "4", then associated Sex (ELG.002.023) value must be "F"12. (Non-Citizen) if value is "2", then associated Citizenship Indicator (ELG.003.040) value must not be equal to "1"13. If value is "D", there must be a corresponding MFP enrollment segment (ELG00010) with Effective and End dates that are within the timespan of this segment14. Value must be 1 character15. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "01", then Eligibility Group (ELG.005.087) must be "23"16. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "03", then Eligibility Group (ELG.005.087) must be "25"17. (Restricted Benefits) if value is "G", then Dual Eligible Code (ELG.005.085) must be in (‘01’, ‘03', ‘06’)	1. Value must be in Restricted Benefits Code List (VVL)2. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "05", then Eligibility Group (ELG.005.087) must be "24"3. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "06", then Eligibility Group (ELG.005.087) must be "26"4. (Restricted Benefits) if value is "1" and Dual Eligible Code (ELG.005.085) value is "02", then Eligibility Group (ELG.005.087) must be "23"5. (Restricted Benefits) if value is "1" and Dual Eligible Code (ELG.005.085) value is "04", then Eligibility Group (ELG.005.087) must be "25"6. (Restricted Benefits) if value is "3", then Dual Eligible Code (ELG.005.085) cannot be "00"7. Mandatory8. If value is populated, then Eligibility Group (ELG.005.087) must be populated9. If value is "6" then Eligibility Group(ELG.DE.087) must be in [35,70]10. If value is "1" or "7" then Eligibility Group (EGL.DE.087) must be in [72,73,74,75] and State Plan Option Type (ELG.DE.163) must equal "06"11. (Restricted Pregnancy-Related) if value is "4", then associated Sex (ELG.002.023) value must be "F"12. (Non-Citizen) if value is "2", then associated Citizenship Indicator (ELG.003.040) value must not be equal to "1"13. If value is "D", there must be a corresponding MFP enrollment segment (ELG00010) with Effective and End dates that are within the timespan of this segment14. Value must be 1 character15. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "01", then Eligibility Group (ELG.005.087) must be "23"16. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "03", then Eligibility Group (ELG.005.087) must be "25"17. (Restricted Benefits) if value is "G", then Dual Eligible Code (ELG.005.085) must be in [01,03,06]
09/12/2024	3.29.0	ELG.005.095	UPDATE	Definition	The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another. Do not populate if at the time someone loses Medicaid eligibility they become eligible for and enrolled in CHIP. Also do not populate if at the time someone loses CHIP eligibility they become eligible for and enrolled in Medicaid.	The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value "21" (Other) or "22" (Unknown), then the state should not report the co-occurring value "21" and/or "22" to T-MSIS. If there are multiple co-occurring distinct values between "01" and "19", then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of "01" through "19", CMS does not currently have a preference for any one value over another. Do not populate if at the time someone loses Medicaid eligibility they become eligible for and enrolled in CHIP. Also do not populate if at the time someone loses CHIP eligibility they become eligible for and enrolled in Medicaid.
09/12/2024	3.29.0	ELG.005.094	UPDATE	Coding requirement	1. Value must be in Conception to Birth Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If the value is equal to "1", then the Eligibility Group (ELG.005.087) must equal "64"5. If the value is equal to "1", then any associated claims must indicate the Program Type = '14' (State Plan CHIP)6. If the value is equal to "1", then CHIP Code (ELG.003.054) must equal "3" (Individual was not Medicaid Expansion CHIP eligible, but was included in a separate title XXI CHIP Program)7. Conditional	1. Value must be in Conception to Birth Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. If the value is equal to "1", then the Eligibility Group (ELG.005.087) must equal "64"5. If the value is equal to "1", then any associated claims must indicate the Program Type = "14" (State Plan CHIP)6. If the value is equal to "1", then CHIP Code (ELG.003.054) must equal "3" (Individual was not Medicaid Expansion CHIP eligible, but was included in a separate title XXI CHIP Program)7. Conditional
09/12/2024	3.29.0	ELG.005.092	UPDATE	Coding requirement	1. Value must be in SSI Status List (VVL)2. Value must be 3 characters3. Conditional4. When value is '001' or '002', then SSI Indicator must be '1'5. When value is '000' or '003' or not populate, then SSI Indicator must be '0'	1. Value must be in SSI Status List (VVL)2. Value must be 3 characters3. Conditional4. When value is "001" or "002", then SSI Indicator must be "1"5. When value is "000" or "003" or not populate, then SSI Indicator must be "0"
09/12/2024	3.29.0	ELG.005.090	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in SSI Indicator List (VVL)4. Value must be 1 character5. Conditional6. Value must equal '0' when SSI status (ELG.005.092) equals '000' or '003' or is not populated7. Value must equal '1' when SSI status (ELG.005.092) equals '001' or '002'	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in SSI Indicator List (VVL)4. Value must be 1 character5. Conditional6. Value must equal "0" when SSI status (ELG.005.092) equals "000" or "003" or is not populated7. Value must equal "1" when SSI status (ELG.005.092) equals "001" or "002"
09/12/2024	3.29.0	ELG.005.087	UPDATE	Coding requirement	Value must be in Eligibility Group List (VVL)2. If value is "26", then Dual Eligible Code value must be "06"3. Conditional4. Value is mandatory and must be provided when associated Eligibility Determinant Effective Date value is on or after 1 January, 2014.5. If value is in [ "72", "73", "74", "75" ], then associated Restricted Benefits Code value must equal "1" or "7" and State Plan Option Type must equal "06"6. If associated CHIP Code value is "2", then value must be in [ "07", 31", "61" ]7. If associated CHIP Code value is "3", then value must be in [ "61", "62", "63", "64", "65", "66", "67", "68" ]8. Value must be 2 characters9. If value is "23", then Dual Eligible Code value must be in ["01", "02"]10. If value is "25", then Dual Eligible Code value must be in ["03", "04"]11. If value is "24", then Dual Eligible Code value must be "05"12. If value is "26", then Dual Eligible Code value must be "06"	1. Value must be in Eligibility Group List (VVL)2. If value is "26", then Dual Eligible Code value must be "06"3. Conditional4. Value is mandatory and must be provided when associated Eligibility Determinant Effective Date value is on or after 1 January, 2014.5. If value is in [72,73,74,75], then associated Restricted Benefits Code value must equal "1" or "7" and State Plan Option Type must equal "06"6. If associated CHIP Code value is "2", then value must be in [07,31,61]7. If associated CHIP Code value is 3,then value must be in [61,62,63,64,65,66,67,68]8. Value must be 2 characters9. If value is "23", then Dual Eligible Code value must be in [01,02]10. If value is "25", then Dual Eligible Code value must be in [03,04]11. If value is "24", then Dual Eligible Code value must be "05"12. If value is "26", then Dual Eligible Code value must be "06"
09/12/2024	3.29.0	ELG.005.086	UPDATE	Definition	A flag indicating the eligibility record is the primary eligibility in cases where there are multiple eligibility records submitted with overlapping or concurrent eligibility determinant effective and end dates. It is expected that an enrollee's eligibility group assignment (ELG087 - ELIGIBILITY-GROUP) will change over time as his/her situation changes. Whenever the eligibility group assignment changes (i.e., ELG087 has a different value), a separate ELIGIBILITY-DETERMINANTS record segment must be created. In such situations, there would be multiple ELIGIBILITY-DETERMINANTS record segments, each covering a different effective time span. In such situations, the value in ELG087 would be the primary eligibility group for the effective date span of its respective ELIGIBILITY-DETERMINANTS record segment, and the PRIMARY-ELIGIBILITY-GROUP-IND data element on each of these segments would be set to '1' (YES). Should a situation arise where a Medicaid/CHIP enrollee has been assigned both a primary and one or more secondary eligibility groups, there would be two or more ELIGIBILITY-DETERMINANTS record segments with overlapping effective time spans - one segment containing the primary eligibility group and the other(s) for the secondary eligibility group(s). To differentiate the primary eligibility group from the secondary group(s), only one segment should be assigned as the primary group using PRIMARY-ELIGIBILITY-GROUP-IND = 1; the others should be assigned PRIMARY-ELIGIBILITY-GROUP-IND = 0.	A flag indicating the eligibility record is the primary eligibility in cases where there are multiple eligibility records submitted with overlapping or concurrent eligibility determinant effective and end dates. It is expected that an enrollee's eligibility group assignment (ELG087 - ELIGIBILITY-GROUP) will change over time as his/her situation changes. Whenever the eligibility group assignment changes (i.e., ELG087 has a different value), a separate ELIGIBILITY-DETERMINANTS record segment must be created. In such situations, there would be multiple ELIGIBILITY-DETERMINANTS record segments, each covering a different effective time span. In such situations, the value in ELG087 would be the primary eligibility group for the effective date span of its respective ELIGIBILITY-DETERMINANTS record segment, and the PRIMARY-ELIGIBILITY-GROUP-IND data element on each of these segments would be set to "1"(YES). Should a situation arise where a Medicaid/CHIP enrollee has been assigned both a primary and one or more secondary eligibility groups, there would be two or more ELIGIBILITY-DETERMINANTS record segments with overlapping effective time spans - one segment containing the primary eligibility group and the other(s) for the secondary eligibility group(s). To differentiate the primary eligibility group from the secondary group(s), only one segment should be assigned as the primary group using PRIMARY-ELIGIBILITY-GROUP-IND = "1"; the others should be assigned PRIMARY-ELIGIBILITY-GROUP-IND = "0".
09/12/2024	3.29.0	ELG.005.086	UPDATE	Coding requirement	1. Value must be in Primary Eligibility Group Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1]4. Mandatory	1. Value must be in Primary Eligibility Group Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1]4. Mandatory
09/12/2024	3.29.0	ELG.005.085	UPDATE	Coding requirement	1. Value must be in Dual Eligible Code List (VVL)2. If value is "05", then Eligibility Group (ELG.005.087) must be "24"3. If value is "06", then Eligibility Group (ELG.005.087) must be "26"4. If Dual Eligible Code (ELG.005.085) is "01", "02", "03", 04", 05", "06", "08", "09", or "10", then Primary Eligibility Group Indicator (ELG.005.086) must be "1" (Yes)5. Mandatory6. A partial dual eligible (values="01', "03", "05" or "06") then Restricted Benefits Code (ELG.005.097) must be "3"7. (Not Dual Eligible) if value = "00", then associated Medicare Beneficiary Identifier (ELG.003.051) value must not be populated.8. Value must be 2 characters9. If value is in ["08", "10"] then Restricted Benefits Code (ELG.005.097) must be "1"10. If value is "09", then Eligibility Group (ELG.005.087) and Restricted Benefits Code (ELG.005.097) must not be populated11. If value equals "10", then CHIP Code (ELG.003.054) must be "03" (S-CHIP) and Medicare Beneficiary Identifier (ELG.003.051) must be populated12. If value is "01", then Eligibility Group (ELG.005.087) must be "23"13. If value is "03", then Eligibility Group (ELG.005.087) must be "25"	1. Value must be in Dual Eligible Code List (VVL)2. If value is "05", then Eligibility Group (ELG.005.087) must be "24"3. If value is "06", then Eligibility Group (ELG.005.087) must be "26"4. If Dual Eligible Code (ELG.005.085) is in [01,02,03,04,05,06,08,09,10], then Primary Eligibility Group Indicator (ELG.005.086) must be "1" (Yes)5. Mandatory6. A partial dual eligible (values 01,03,05,06) must have a Restricted Benefits Code (ELG.005.097) equal to "3"7. (Not Dual Eligible) if value = "00", then associated Medicare Beneficiary Identifier (ELG.003.051) value must not be populated.8. Value must be 2 characters9. If value is in ["08", "10"] then Restricted Benefits Code (ELG.005.097) must be "1"10. If value is "09", then Eligibility Group (ELG.005.087) and Restricted Benefits Code (ELG.005.097) must not be populated11. If value equals "10", then CHIP Code (ELG.003.054) must be "03" (S-CHIP) and Medicare Beneficiary Identifier (ELG.003.051) must be populated12. If value is "01", then Eligibility Group (ELG.005.087) must be "23"13. If value is "03", then Eligibility Group (ELG.005.087) must be "25"
09/12/2024	3.29.0	ELG.004.076	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.004.075	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.004.073	UPDATE	Coding requirement	1. Value must be 10-digit number2. Conditional3. If Eligible Address Type (ELG.004.065) = ''01', then value is mandatory and must be provided	1. Value must be 10-digit number2. Conditional3. If Eligible Address Type (ELG.004.065) equals "01", then value is mandatory and must be provided
09/12/2024	3.29.0	ELG.004.065	UPDATE	Coding requirement	1. Value must be in Eligible Address Type List (VVL)2. Value must be 2 characters3. Mandatory	1. Value must be in Eligible Address Type List (VVL)2. Value must be 2 characters3. Mandatory4. When Address Type equals "01" (Primary), Eligible State (ELG.004.070) must equal Submitting State (ELG.001.007)
09/12/2024	3.29.0	ELG.003.269	UPDATE	Definition	This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.	This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.
09/12/2024	3.29.0	ELG.003.058	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.003.057	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.003.054	UPDATE	Coding requirement	1. Value must be in CHIP Code List (VVL)2. If value is in [ 2, 3 ], then associated Eligibility Group (ELG.005.087) value must be in [ "07", "31", "61", 62", "63", "64", "65", "66", "67", or "68" ]3. If value is "1", then associated Eligibility Group (ELG.005.087) value must not be in [ "61", 62", "63", "64", "65", "66", "67", or "68" ]4. Value must be 1 character5. Mandatory	1. Value must be in CHIP Code List (VVL)2. If value is in [ 2, 3 ], then associated Eligibility Group (ELG.005.087) value must be in [07,31,61,62,63,64,65,66,67,68 ]3. If value is 1, then associated Eligibility Group (ELG.005.087) value must not be in [61,62,63,64,65,66,67,68]4. Value must be 1 character5. Mandatory
09/12/2024	3.29.0	ELG.003.051	UPDATE	Coding requirement	1. Conditional2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S, L, O, I, B, Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S, L, O, I, B, Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)11. Character 9 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols15. When Dual Eligible Code (ELG.005.085) equals '00' and End of Time Period (ELG.001.010) greater than or equal to '2015-11-01', value should not be populated16. (Medicare Enrolled) if associated Dual Eligible Code value (ELG.005.085) is in [ "01", "02", "03", "04", "05", "06", "08", "09", or "10" ], then the value for either HICN or MBI is mandatory and must be provided	1. Conditional2. Value must be an 11 character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols15. When Dual Eligible Code (ELG.005.085) equals "00" and End of Time Period (ELG.001.010) greater than or equal to "2015-11-01", value should not be populated16. (Medicare Enrolled) if associated Dual Eligible Code value (ELG.005.085) is in [ "01", "02", "03", "04", "05", "06", "08", "09", or "10" ], then the value for either HICN or MBI is mandatory and must be provided
09/12/2024	3.29.0	ELG.003.050	UPDATE	Coding requirement	1. Conditional2. Value must be 12 characters or less3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value = "00", then value must not be populated.5. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in [ "01", "02", "03", "04", "05", "06", "08", "09", or "10" ], then value for either HICN or MBI is mandatory and must be provided	1. Conditional2. Value must be 12 characters or less3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value = "00", then value must not be populated.5. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06, 08,09,10], then value for either HICN or MBI is mandatory and must be provided
09/12/2024	3.29.0	ELG.003.044	UPDATE	Coding requirement	1. Conditional2. (U.S. Citizen) value should not be populated when Immigration Status (ELG.003.042) equals '8'	1. Conditional2. (U.S. Citizen) value should not be populated when Immigration Status (ELG.003.042) equals "8"
09/12/2024	3.29.0	ELG.003.042	UPDATE	Coding requirement	1. Value must be in Immigration Status List (VVL)2. If associated Citizenship Indicator (ELG.003.040) value is coded as '0', then value must be in [ 1, 2, 3 ]3. If associated Citizenship Indicator (ELG.003.040) value is coded as '1', then value must equal '8'4. Value must be 1 character5. Mandatory	1. Value must be in Immigration Status List (VVL)2. If associated Citizenship Indicator (ELG.003.040) value is coded as "0", then value must be in [ 1, 2, 3 ]3. If associated Citizenship Indicator (ELG.003.040) value is coded as "1", then value must equal "8"4. Value must be 1 character5. Mandatory
09/12/2024	3.29.0	ELG.003.041	UPDATE	Coding requirement	1. Value must be in Citizenship Verification Flag List (VVL)2. Value must be 1 character3. Value must be populated when Citizenship Indicator (ELG.003.040) equals '1' (Yes)4. Conditional	1. Value must be in Citizenship Verification Flag List (VVL)2. Value must be 1 character3. Value must be populated when Citizenship Indicator (ELG.003.040) equals "1" (Yes)4. Conditional
09/12/2024	3.29.0	ELG.003.040	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in Citizenship Indicator List (VVL)3. If value is coded as '0', then associated Immigration Status (ELG.003.042) value must be in [ 1, 2, 3 ]4. If value is coded as '1', then associated Immigration Status (ELG.003.042) value must equal '8'5. Mandatory	1. Value must be 1 character2. Value must be in Citizenship Indicator List (VVL)3. If value is coded as "0", then associated Immigration Status (ELG.003.042) value must be in [ 1, 2, 3 ]4. If value is coded as "1", then associated Immigration Status (ELG.003.042) value must equal "8"5. Mandatory
09/12/2024	3.29.0	ELG.003.039	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Veteran Indicator List (VVL)4. Conditional5. Value must be populated when Immigration Status (ELG.003.042) is in ['1', '2', '3']	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Veteran Indicator List (VVL)4. Conditional5. Value must be populated when Immigration Status (ELG.003.042) is in [1,2,3]
09/12/2024	3.29.0	ELG.003.038	UPDATE	Definition	A code indicating the federal poverty level range in which the family income falls.If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.	A code indicating the federal poverty level range in which the family income falls. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.
09/12/2024	3.29.0	ELG.003.035	UPDATE	Coding requirement	1. If associated Marital Status (ELG.003.035) equals '14' (Other), then value is mandatory and must be provided2. Value must be 50 characters or less3. Value must not contain a pipe or asterisk symbol4. Conditional	1. If associated Marital Status (ELG.003.035) equals "14" (Other), then value is mandatory and must be provided2. Value must be 50 characters or less3. Value must not contain a pipe or asterisk symbol4. Conditional
09/12/2024	3.29.0	ELG.003.034	UPDATE	Definition	A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization).Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the state’s marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value.	A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization). Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the state’s marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value.
09/12/2024	3.29.0	ELG.002.027	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20', '99']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be greater than or equal to associated Segment Effective Date value4. Mandatory5. Value of the CC component must be in [18,19,20,99]
09/12/2024	3.29.0	ELG.002.026	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/12/2024	3.29.0	ELG.002.024	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Children enrolled in the Separate CHIP prenatal program option should have a date of birth missing or a date of birth equal to the pregnant mother's date of birth4. When Conception to Birth Indicator (ELG.005.094) does not equal '1' and Eligibility Group (ELG.005.087) does not equal '64' value must be less than or equal to associated End of Time Period value5. Value must be less than or equal to associated Date File Created (ELG.001.008) value6. Mandatory7. When Conception to Birth Indicator (ELG.005.094) does not equal '1' and Eligibility Group (ELG.005.087) does not equal '64' value minus Start of Time Period (ELG.001.10) must be less than 125 years	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Children enrolled in the Separate CHIP prenatal program option should have a date of birth missing or a date of birth equal to the pregnant mothers date of birth4. When Conception to Birth Indicator (ELG.005.094) does not equal "1" and Eligibility Group (ELG.005.087) does not equal "64" value must be less than or equal to associated End of Time Period value5. Value must be less than or equal to associated Date File Created (ELG.001.008) value6. Mandatory7. When Conception to Birth Indicator (ELG.005.094) does not equal "1" and Eligibility Group (ELG.005.087) does not equal "64" value minus Start of Time Period (ELG.001.10) must be less than 125 years
09/12/2024	3.29.0	ELG.002.023	UPDATE	Coding requirement	1. Value must be in Sex List (VVL)2. Value must be 1 character3. (Pregnancy) if value equals "M", then associated Pregnancy Indicator (ELG.003.049) value must not equal '1'4. Mandatory	1. Value must be in Sex List (VVL)2. Value must be 1 character3. (Pregnancy) if value equals "M", then associated Pregnancy Indicator (ELG.003.049) value must not equal "1"4. Mandatory
09/12/2024	3.29.0	ELG.001.011	UPDATE	Coding requirement	1. For production files, value must be equal to 'P'2. Value must be in File Status Indicator List (VVL)3. Value must be 1 character4. Mandatory	1. For production files, value must be equal to "P"2. Value must be in File Status Indicator List (VVL)3. Value must be 1 character4. Mandatory
09/12/2024	3.29.0	ELG.001.006	UPDATE	Coding requirement	1. Value must equal 'ELIGIBLE'2. Mandatory	1. Value must equal "ELIGIBLE"2. Mandatory
09/12/2024	3.29.0	CRX.003.172	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1]3. Mandatory	1. Value must be 1 character2. Value must be in [0,1]3. Mandatory
09/12/2024	3.29.0	CRX.003.171	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CRX.003.170	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CRX.003.169	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CRX.003.168	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CRX.003.167	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CRX.003.152	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CRX.003.151	UPDATE	Coding requirement	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '02', then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is "02", then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less
09/12/2024	3.29.0	CRX.003.150	UPDATE	Coding requirement	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is '01', then a valid value is mandatory and must be reported5. If value is in ['14', '35', '42' or '44'], then Sex (ELG.002.023) must not equals 'M'6. If XXI MBESCBES Category of Service is populated then must not be populated	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is "01", then a valid value is mandatory and must be reported5. If value is in [14,35,42,44], then Sex (ELG.002.023) must not equals "M"6. If XXI MBESCBES Category of Service is populated then must not be populated
09/12/2024	3.29.0	CRX.003.149	UPDATE	Coding requirement	1. Value must be in CMS 64 Category for Federal Reimbursement List (VVL)2. Value must be 2 characters3. (Federal Funding under Title XXI) if value equals '02', then the eligible's CHIP Code (ELG.003.054) must be in ['2', '3']4. (Federal Funding under Title XIX) if value equals '01' then the eligible's CHIP Code (ELG.003.054) must be '1'5. Conditional6. If Type of Claim is in ['1','2','5','A','B','E','U','V','Y'] and the Total Medicaid Paid Amount is populated on the corresponding claim header, then value must be reported.7. If Type of Claim is in ['4','D'] and the Service Tracking Payment Amount on the relevant record is populated, then value must be reported.	1. Value must be in CMS 64 Category for Federal Reimbursement List (VVL)2. Value must be 2 characters3. (Federal Funding under Title XXI) if value equals "02", then the eligibles CHIP Code (ELG.003.054) must be in [2, 3]4. (Federal Funding under Title XIX) if value equals "01" then the eligible's CHIP Code (ELG.003.054) must be "1"5. Conditional6. If Type of Claim is in [1,2,5,A,B,E,U,V,Y] and the Total Medicaid Paid Amount is populated on the corresponding claim header, then value must be reported.7. If Type of Claim is in [4,D] and the Service Tracking Payment Amount on the relevant record is populated, then value must be reported.
09/12/2024	3.29.0	CRX.003.147	UPDATE	Coding requirement	Not Applicable
09/12/2024	3.29.0	CRX.003.144	UPDATE	Coding requirement	1. Value must be numeric2. Value may include up to 7 digits to the left of the decimal point, and 3 digits to the right, e.g. 1234567.8903. Value must be populated when Compound Drug Indicator (CRX.002.086) equals 14. Conditional	1. Value must be numeric2. Value may include up to 7 digits to the left of the decimal point, and 3 digits to the right, e.g. 1234567.8903. Value must be populated when Compound Drug Indicator (CRX.002.086) equals "1"4. Conditional
09/12/2024	3.29.0	CRX.003.143	UPDATE	Definition	A code indicating the conflict, intervention and outcome of a prescription presented for fulfillment. The T-MSIS Drug Utilization Code data element is composite field comprised of three distinct NCPDP data elements: "Reason for Service Code" (439-E4); "Professional Service Code" (440-E5); and "Result of Service Code" (441-E6). All 3 of these NCPDP fields are situationally required and independent of one another. Pharmacists may report none, one, two or all three. NCPDP situational rules call for one or more of these values in situations where the field(s) could result in different coverage, pricing, patient financial responsibility, drug utilization review outcome, or if the information affects payment for, or documentation of, professional pharmacy service. The NCPDP "Reasons of Service Code" (bytes 1 & 2 of the T-MSIS DRUG-UTILIZATION-CODE) explains whether the pharmacist filled the prescription, filled part of the prescription, etc. The NCPDP "Professional Service Code" (bytes 3 & 4 of the T-MSIS Drug Utilization Code) describes what the pharmacist did for the patient. The NCPDP "Result of Service Code" (bytes 5 & 6 of the T-MSIS Drug Utilization Code) describes the action the pharmacist took in response to a conflict or the result of a pharmacist's professional service. Because the T-MSIS Drug Utilization Code data element is a composite field, it is necessary for the state to populate all six bytes if any of the three NCPDP fields has a value. In such situations, use 'spaces' as placeholders for not applicable codes.	A code indicating the conflict, intervention and outcome of a prescription presented for fulfillment. The T-MSIS Drug Utilization Code data element is composite field comprised of three distinct NCPDP data elements: "Reason for Service Code" (439-E4); "Professional Service Code" (440-E5); and "Result of Service Code" (441-E6). All 3 of these NCPDP fields are situationally required and independent of one another. Pharmacists may report none, one, two or all three. NCPDP situational rules call for one or more of these values in situations where the field(s) could result in different coverage, pricing, patient financial responsibility, drug utilization review outcome, or if the information affects payment for, or documentation of, professional pharmacy service. The NCPDP "Reasons of Service Code" (bytes 1 & 2 of the T-MSIS DRUG-UTILIZATION-CODE) explains whether the pharmacist filled the prescription, filled part of the prescription, etc. The NCPDP "Professional Service Code" (bytes 3 & 4 of the T-MSIS Drug Utilization Code) describes what the pharmacist did for the patient. The NCPDP "Result of Service Code" (bytes 5 & 6 of the T-MSIS Drug Utilization Code) describes the action the pharmacist took in response to a conflict or the result of a pharmacist"s professional service. Because the T-MSIS Drug Utilization Code data element is a composite field, it is necessary for the state to populate all six bytes if any of the three NCPDP fields has a value. In such situations, use "spaces" as placeholders for not applicable codes.
09/12/2024	3.29.0	CRX.003.141	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value may include up to 6 digits to the left of the decimal point, and 2 digits to the right e.g. 123456.784. Mandatory	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value may include up to 6 digits to the left of the decimal point, and 2 digits to the right e.g. 123456.784. Mandatory
09/12/2024	3.29.0	CRX.003.136	UPDATE	Coding requirement	1. Value must be in HCBS Taxonomy Code List (VVL).2. Value must be 5 characters or less3. Conditional	1. Value must be in HCBS Taxonomy Code List (VVL)2. Value must be 5 characters or less3. Conditional
09/12/2024	3.29.0	CRX.003.135	UPDATE	Coding requirement	1. Value must be in HCBS Service Code List (VVL).2. Value must be 1 character3. If value is 1-7, then HCBS Taxonomy must be populated.4. Conditional	1. Value must be in HCBS Service Code List (VVL)2. Value must be 1 character3. If value is in [1-7], then HCBS Taxonomy must be populated.4. Conditional
09/12/2024	3.29.0	CRX.003.134	UPDATE	Coding requirement	1. Value must be 3 characters2. Mandatory3. Value must be in ['011', '018', '033', '034', '036', '085', '089', '127', '131', '136', '137', '145']	1. Value must be 3 characters2. Mandatory3. Value must be in [011,018,033,034,036,085,089,127,131,136,137,145]
09/12/2024	3.29.0	CRX.003.133	UPDATE	Coding requirement	1. Value must be in NDC Unit of Measure List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in NDC Unit of Measure List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CRX.003.132	UPDATE	Coding requirement	1. Value may include up to 8 digits to the left of the decimal point, and 3 digits to the right e.g. 12345678.9992. Conditional3. If Type of Claim is in [1, 3, A, C, U, W], then this value must be reported.4. When populated, corresponding Unit of Measure must be populated	1. Value may include up to 8 digits to the left of the decimal point, and 3 digits to the right e.g. 12345678.9992. Conditional3. If Type of Claim is in [1,3,A,C,U,W], then this value must be reported.4. When populated, corresponding Unit of Measure must be populated
09/12/2024	3.29.0	CRX.003.129	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is "0", then the value must not be populated.4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value is "0", then the value must not be populated.4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"
09/12/2024	3.29.0	CRX.003.128	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Medicare Combined Deductible Indicator is '1', then value must not be populated (or must be 99998)4. Value must not be populated if Medicare Deductible Amount is not populated5. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Medicare Combined Deductible Indicator is "1", then value must not be populated (or must be 99998)4. Value must not be populated if Medicare Deductible Amount is not populated5. Conditional
09/12/2024	3.29.0	CRX.003.127	UPDATE	Definition	The amount paid by Medicaid/CHIP on this claim at the claim line level toward the beneficiary's Medicare deductible. If the Medicare deductible amount can be identified separately from Medicare coinsurance payments, code that amount in this field. If the Medicare coinsurance and deductible payments cannot be separated, fill this field with the combined payment amount and Medicare Coinsurance Payment is not required.	The amount paid by Medicaid/CHIP on this claim at the claim line level toward the beneficiary"s Medicare deductible. If the Medicare deductible amount can be identified separately from Medicare coinsurance payments, code that amount in this field. If the Medicare coinsurance and deductible payments cannot be separated, fill this field with the combined payment amount and Medicare Coinsurance Payment is not required.
09/12/2024	3.29.0	CRX.003.127	UPDATE	Coding requirement	Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional4. If associated Crossover Indicator value is '0' (not a crossover claim), value should not be populated5. If value is greater than '0,' then Crossover Indicator must be '1'	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional4. If associated Crossover Indicator value is "0" (not a crossover claim), then value should not be populated5. If value is greater than "0", then Crossover Indicator must be "1"
09/12/2024	3.29.0	CRX.003.126	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim value equals '3, C, W', then value is mandatory and must be provided4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Type of Claim value in [3,C,W], then value is mandatory and must be provided4. Conditional
09/12/2024	3.29.0	CRX.003.125	UPDATE	Definition	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The amount paid to the provider by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CRX.003.125	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CRX.003.124	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CRX.003.122	UPDATE	Definition	The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity allowed at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The maximum amount displayed at the claim line level as determined by the payer as being "allowable" under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state"s MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity allowed at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CRX.003.122	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CRX.003.121	UPDATE	Definition	The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CRX.003.121	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CRX.003.119	UPDATE	Coding requirement	1. Value must be in Claim Status List (VVL)2. Value must be 3 characters or less3. Conditional4. If value in [545, 585, 654], then Claim Denied Indicator must be '0' and Claim Status Category must be 'F2'	1. Value must be in Claim Status List (VVL)2. Value must be 3 characters or less3. Conditional4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2"
03/14/2025	3.35.0	CRX.003.118	UPDATE	Necessity	Mandatory	Conditional
03/14/2025	3.35.0	CRX.003.118	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Mandatory	1. Value must be 12 characters or less2. Conditional
09/12/2024	3.29.0	CRX.003.116	UPDATE	Coding requirement	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [1,3,5,A,C,E,U,W,Y], then value must be in [0,1,4]3. If associated Type of Claim value is in [4,D,X], then value must be in [5,6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated
09/12/2024	3.29.0	CRX.003.115	UPDATE	Coding requirement	1. Value must be 3 characters or less2. If associated Line Adjustment Indicator value is 0, then value must not be populated3. If associated Line Adjustment Indicator value is 1, then value is mandatory and must be provided4. Conditional5. When populated, value must be one or greater	1. Value must be 3 characters or less2. If associated Line Adjustment Indicator value is 0, then value must not be populated3. If associated Line Adjustment Indicator value is "1", then value is mandatory and must be provided4. Conditional5. When populated, value must be one or greater
09/12/2024	3.29.0	CRX.003.113	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [‘4’, ‘1’] then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
09/12/2024	3.29.0	CRX.003.111	UPDATE	Coding requirement	1. Mandatory2. Value must be 20 characters or less3. When TYPE-OF-CLAIM = 4, D or X (lump sum payment), value must begin with an '&'	1. Mandatory2. Value must be 20 characters or less3. When TYPE-OF-CLAIM is in [4,D,X] (lump sum payment), value must begin with an "&"
09/12/2024	3.29.0	CRX.002.166	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. Conditional
09/12/2024	3.29.0	CRX.002.165	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. Conditional
09/12/2024	3.29.0	CRX.002.164	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. Conditional
09/12/2024	3.29.0	CRX.002.163	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. Conditional
12/10/2024	3.33.0	CRX.002.162	UPDATE	Medicaid valid value info		See https://www.ncpdp.org/
09/12/2024	3.29.0	CRX.002.160	UPDATE	Coding requirement	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If value equals '1', then Total Medicare Coinsurance amount must not be populated.5. If value equals '0', then Crossover Indicator must equals '0'6. If value equals '1', then Crossover Indicator must equals '1'7. Conditional	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. If value equals "1", then Total Medicare Coinsurance amount must not be populated5. If value equals "0", then Crossover Indicator must equals "0"6. If value equals "1", then Crossover Indicator must equals "1"7. Conditional
09/12/2024	3.29.0	CRX.002.156	UPDATE	Coding requirement	1. Value must be 30 characters or less2. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match Submitting State Provider ID (PRV.002.019) or3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match Provider Identifier (PRV.005.081) where the Provider Identifier Type (PRV.005.077) = '1'4. Mandatory	1. Value must be 30 characters or less2. When Type of Claim not in [Z,3,C,W,2,B,V,4,D,X] then value may match Submitting State Provider ID (PRV.002.019) or3. When Type of Claim not in [Z,3,C,W,2,B,V,4,D,X] then value may match Provider Identifier (PRV.005.081) where the Provider Identifier Type (PRV.005.077) equals "1"4. Mandatory
09/12/2024	3.29.0	CRX.002.105	UPDATE	Coding requirement	1. Conditional2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S, L, O, I, B, Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S, L, O, I, B, Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)11. Character 9 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols	1. Conditional2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols
09/12/2024	3.29.0	CRX.002.104	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. Value must exist in the NPPES NPI data file	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. Value must exist in the NPPES NPI data file
09/12/2024	3.29.0	CRX.002.102	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2'3. When Type of Claim not in ('3','C','W') then value must match Provider Identifier (PRV.005.081)4. Mandatory5. Value must exist in the NPPES NPI data file6. Nppes Entity Type Code associate with this NPI must equal ‘1’ (Individual)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to "2"3. When Type of Claim not in [3,C,W] then value must match Provider Identifier (PRV.005.081)4. Mandatory5. Value must exist in the NPPES NPI data file6. Nppes Entity Type Code associate with this NPI must equal "1" (Individual)
09/12/2024	3.29.0	CRX.002.100	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Situational	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. Situational
09/12/2024	3.29.0	CRX.002.098	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Situational	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. Situational
09/12/2024	3.29.0	CRX.002.094	UPDATE	Coding requirement	1. Value must be in Claim Denied Indicator List (VVL)2. If value is '0', then Claim Status Category must equal "F2"3. Value must be 1 character4. Mandatory	1. Value must be in Claim Denied Indicator List (VVL)2. If value is "0", then Claim Status Category must equal "F2"3. Value must be 1 character4. Mandatory
09/12/2024	3.29.0	CRX.002.093	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Beneficiary Deductible Amount4. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Beneficiary Deductible Amount4. Conditional
09/12/2024	3.29.0	CRX.002.092	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. Conditional
09/12/2024	3.29.0	CRX.002.088	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Beneficiary Coinsurance Amount4. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Beneficiary Coinsurance Amount4. Conditional
09/12/2024	3.29.0	CRX.002.090	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Beneficiary Copayment Amount4. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Beneficiary Copayment Amount4. Conditional
09/12/2024	3.29.0	CRX.002.089	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. Conditional
09/12/2024	3.29.0	CRX.002.087	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. Conditional
09/12/2024	3.29.0	CRX.002.086	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Compound Drug Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Compound Drug Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	CRX.002.085	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be on or before associated End of Time Period (CRX.001.010)4. Value must be on or after associated Start of Time Period (CRX.001.009)5. Value must be on or after associated Date Prescribed (CRX.002.084)6. Value must be on or after associated eligible party's Date of Birth (ELG.002.024)7. Value must be on or before associated eligible party's Date of Death (ELG.002.025)8. Value must be populated when Adjustment Indicator (CRX.002.025) does not equal '1' and Type of Claim (CRX.002.029) does not equal 'Z'9. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be on or before associated End of Time Period (CRX.001.010)4. Value must be on or after associated Start of Time Period (CRX.001.009)5. Value must be on or after associated Date Prescribed (CRX.002.084)6. Value must be on or after associated eligible party's Date of Birth (ELG.002.024)7. Value must be on or before associated eligible party's Date of Death (ELG.002.025)8. Value must be populated when Adjustment Indicator (CRX.002.025) does not equal "1" and Type of Claim (CRX.002.029) does not equal "Z"9. Mandatory
09/12/2024	3.29.0	CRX.002.084	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be on or after associated eligible party's Date of Birth (ELG.002.024)4. Value must be on or before associated Prescription Fill Date (CRX.002.085)5. Value must be on or before associated Adjudication Date (CRX.002.027)6. Value must be on or before associated eligible party's Date of Death (ELG.002.025)7. Mandatory8. Value should be on or before End of Time Period (CRX.001.010)	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be on or after associated eligible party's Date of Birth (ELG.002.024)4. Value must be on or before associated Prescription Fill Date (CRX.002.085)5. Value must be on or before associated Adjudication Date (CRX.002.027)6. Value must be on or before associated eligible party's Date of Death (ELG.002.025)7. Mandatory8. Value should be on or before End of Time Period (CRX.001.010)
09/12/2024	3.29.0	CRX.002.082	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Border State Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Border State Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	CRX.002.079	UPDATE	Coding requirement	1. Conditional2. Value must be 12 characters or less3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value = "00", then value must not be populated.5. Value must be populated when Crossover Indicator (CRX.002.023) equals '1' and Medicare Beneficiary Identifier (CRX.002.105) must not be populated.	1. Conditional2. Value must be 12 characters or less3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.De085) value = "00", then value must not be populated5. Value must be populated when Crossover Indicator (CRX.002.023) equals "1" and Medicare Beneficiary Identifier (CRX.002.105) must not be populated
09/12/2024	3.29.0	CRX.002.073	UPDATE	Coding requirement	1. Value must be in Provider Specialty List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Provider Specialty List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CRX.002.071	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2'3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal '01'6. When Type of Claim is in ['1','3','A','C'], then value must be populated7. When Type of Claim not in ('3','C','W') then value must match Provider Identifier (PRV.002.081) 8. NPPES Entity Type Code associated with this NPI must equal ‘2’ (Organization)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. When Type of Claim is in [1,3,A,C], then value must be populated7. When Type of Claim not in [3,C,W] then value must match Provider Identifier (PRV.002.081)8. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)
09/12/2024	3.29.0	CRX.002.070	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.081) equal to '1' 5. When Type of Claim is in ['1','3','A','C'], then value must be populated 6. When Type of Claim in ('1','3','A','C’) then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in ['01', '02', '03', '04', '05', '06'] (active)7. Prescription Fill Date (CRX.002.085) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or 8. Prescription Fill Date (CRX.002.085) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [Z,3,C,W,2,B,V,4,D,X] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [Z,3,C,W,2,B,V,4,D,X] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.081) equal to "1"5. When Type of Claim is in [1,3,A,C], then value must be populated6. When Type of Claim in [1,3,A,C] then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in [01,02,03,04,05,06] (active)7. Prescription Fill Date (CRX.002.085) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Prescription Fill Date (CRX.002.085) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)
09/12/2024	3.29.0	CRX.002.069	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by a version number [0-9] in the 12th position 5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be "01" or in [21-30](1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional
09/12/2024	3.29.0	CRX.002.068	UPDATE	Coding requirement	1. Value must be in Waiver Type List (VVL)2. Value must be 2 characters3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waive ID (CRX.002.069)5. Conditional6. Value must be in [ '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20', '33'] when associated Program Type equals "07"	1. Value must be in Waiver Type List (VVL)2. Value must be 2 characters3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waive ID (CRX.002.069)5. Conditional6. Value must be in [06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,33] when associated Program Type equals "07"
09/12/2024	3.29.0	CRX.002.067	UPDATE	Coding requirement	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Conditional	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Conditional
09/12/2024	3.29.0	CRX.002.066	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e Feb 29th only on the leap year, never April 31st or Sept 31st)3. Mandatory
09/12/2024	3.29.0	CRX.002.061	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Forced Claim Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Forced Claim Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	CRX.002.060	UPDATE	Coding requirement	1. Value must be a positive integer2. Value must be between 0:9999 (inclusive)3. Value must not include commas or other non-numeric characters4. Value must be equal to the number of claim lines (e.g. Original Claim Line Number or Adjustment Claim Line Number instances) reported in the associated claim record being reported5. Value must be 4 characters or less6. Mandatory	1. Value must be a positive integer2. Value must be between 0:9999 (inclusive)3. Value must not include commas or other non-numeric characters4. Value must be equal to the number of claim lines (eg. Original Claim Line Number or Adjustment Claim Line Number instances) reported in the associated claim record being reported5. Value must be 4 characters or less6. Mandatory
09/12/2024	3.29.0	CRX.002.059	UPDATE	Coding requirement	1. Value must be in Medicare Reimbursement Type List (VVL)2. Value is mandatory and must be provided, when Crossover Indicator is equal to '1' (Crossover Claim)3. Value must be 2 characters4. Conditional	1. Value must be in Medicare Reimbursement Type List (VVL)2. Value is mandatory and must be provided, when Crossover Indicator is equal to "1" (Crossover Claim)3. Value must be 2 characters4. Conditional
09/12/2024	3.29.0	CRX.002.058	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level.For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only.For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
09/12/2024	3.29.0	CRX.002.056	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional4. Value must match Managed Care Plan ID (ELG.014.192)5. Value must match State Plan ID Number (MCR.002.019)6. Value should be populated when Type of Claim (CRX.002.029) is in [3, C, W, 2, B, V]7. When Type of Claim in (3, C, W, 2, B, V) value must have a Managed Care Enrollment (ELG.014) for the beneficiary where the Prescription Fill Date (CRX.002.085) occurs between the managed care plan enrollment eff/end dates (ELG.014.197/198)8. When Type of Claim in (3, C, W, 2, B, V) value must have a Managed Care Main Record (MCR.002) for the plan where the Prescription Fill Date (CRX.002.085) occurs between the managed care contract eff/end dates (MCR.002.020/021)	1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional4. Value must match Managed Care Plan ID (ELG.014.192)5. Value must match State Plan ID Number (MCR.002.019)6. Value should be populated when Type of Claim (CRX.002.029) is in [3,C,W,2,B,V]7. When Type of Claim in [3,C,W,2,B,V] value must have a Managed Care Enrollment (ELG.014) for the beneficiary where the Prescription Fill Date (CRX.002.085) occurs between the managed care plan enrollment eff/end dates (ELG.014.197/198)8. When Type of Claim in [3,C,W,2,B,V] value must have a Managed Care Main Record (MCR.002) for the plan where the Prescription Fill Date (CRX.002.085) occurs between the managed care contract eff/end dates (MCR.002.020/021)
09/12/2024	3.29.0	CRX.002.055	UPDATE	Coding requirement	1. Value must be in Program Type List (VVL)2. Value must be 2 characters3. Mandatory4. (Community First Choice) If value equals '11', then State Plan Option Type (ELG.011.163) must equal '01' for the same time period5. If value equals '13', then State Plan Option Type (ELG.011.163) must equal '02' for the same time period	1. Value must be in Program Type List (VVL)2. Value must be 2 characters3. Mandatory4. (Community First Choice) If value equals "11", then State Plan Option Type (ELG.011.163) must equal "01" for the same time period5. If value equals "13", then State Plan Option Type (ELG.011.163) must equal "02" for the same time period
09/12/2024	3.29.0	CRX.002.054	UPDATE	Coding requirement	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Value must be populated if Type of Claim in not in [3,C,W,6]4. Conditional
09/12/2024	3.29.0	CRX.002.053	UPDATE	Coding requirement	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Value must be populated if Type of Claim in not in [3,C,W,6]4. Conditional
09/12/2024	3.29.0	CRX.002.052	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Fixed Payment Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Fixed Payment Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	CRX.002.051	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim value is in [4, D, or X], then value is mandatory and must be provided4. Conditional5. When populated, Service Tracking Type must be populated6. When populated, Total Medicaid Amount must not be populated	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. If associated Type of Claim value is in [4,D,X], then value is mandatory and must be provided4. Conditional5. When populated, Service Tracking Type must be populated6. When populated, Total Medicaid Amount must not be populated
09/12/2024	3.29.0	CRX.002.050	UPDATE	Coding requirement	1. Value must be in Service Tracking Type List (VVL)2. (Service Tracking Claim) if associated Type of Claim is in ['4','D', 'X'] then value is mandatory and must be reported3. Value must be 2 characters4. Conditional	1. Value must be in Service Tracking Type List (VVL)2. (Service Tracking Claim) if associated Type of Claim is in [4,D,X] then value is mandatory and must be reported3. Value must be 2 characters4. Conditional
09/12/2024	3.29.0	CRX.002.048	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	CRX.002.047	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. Conditional
09/12/2024	3.29.0	CRX.002.045	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional
09/12/2024	3.29.0	CRX.002.044	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is '0' (not a crossover claim), then value should not be populated.4. Conditional5. If associated Medicare Combined Deductible Indicator is '1', then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. If associated Crossover Indicator value is "0" (not a crossover claim), then value should not be populated4. Conditional5. If associated Medicare Combined Deductible Indicator is "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount
09/12/2024	3.29.0	CRX.002.043	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is '0' (not a crossover claim), then value should not be populated.4. Conditional5. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. If associated Crossover Indicator value is "0" (not a crossover claim), then value should not be populated4. Conditional5. When populated, value must be less than or equal to Total Billed Amount
09/12/2024	3.29.0	CRX.002.041	UPDATE	Definition	The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider.	The total amount paid to the provider by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider.
09/12/2024	3.29.0	CRX.002.041	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must be populated, when Type of Claim is in [‘1’, ‘A’]8. Value must not be populated or equal to ‘0.00’ when associated Claim Status is in ['26', '026', '87', '087', '542', '585', '654']9. Value should not be populated, when associated Type of Claim value is in [‘4’, ‘D’]	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts6. Conditional7. Value must be populated, when Type of Claim is in [1,A]8. Value must not be populated or equal to ‘0.00’ when associated Claim Status is in [26,026,87,087,542,585,654]9. Value should not be populated, when associated Type of Claim value is in [4,D]
09/12/2024	3.29.0	CRX.002.040	UPDATE	Definition	The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity allowed for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The claim header level maximum amount determined by the payer as being "allowable" under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state"s MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity allowed for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CRX.002.040	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. When populated and Payment Level Indicator = '2' then value must equal the sum of all claim line Allowed Amount values4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. When populated and Payment Level Indicator = "2" then value must equal the sum of all claim line Allowed Amount values4. Conditional
09/12/2024	3.29.0	CRX.002.039	UPDATE	Definition	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CRX.002.039	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. When associated Type of Claim in [‘1’, ’3’, ’A’, ’C’], value must be populated	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. When associated Type of Claim in [1,3,A,C] and Source Location does not equal "23", value must be populated
09/12/2024	3.29.0	CRX.002.034	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Check Number4. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Check Number4. Conditional
09/12/2024	3.29.0	CRX.002.032	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = "22" to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = "23" to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.
09/12/2024	3.29.0	CRX.002.031	UPDATE	Coding requirement	1. Value must be in Claim Status Category List (VVL)2. (Denied Claim) if associated Claim Denied Indicator indicates the claim was denied, then value must be "F2"3. (Denied Claim) if associated Claim Status is in [ 542, 585, 654 ], then value must be "F2"4. Value must be 3 characters or less5. Mandatory	1. Value must be in Claim Status Category List (VVL)2. (Denied Claim) if associated Claim Denied Indicator indicates the claim was denied, then value must be "F2"3. (Denied Claim) if associated Claim Status is in [542,585,654], then value must be "F2"4. Value must be 3 characters or less5. Mandatory
09/12/2024	3.29.0	CRX.002.030	UPDATE	Coding requirement	1. Value must be in Claim Status List (VVL)2. Value must be 3 characters or less3. Conditional4. If value in [ 542, 585, 654 ], Claim Denied Indicator must be '0' and Claim Status Category must be 'F2'	1. Value must be in Claim Status List (VVL)2. Value must be 3 characters or less3. Conditional4. If value in [ 542, 585, 654 ], Claim Denied Indicator must be "0" and Claim Status Category must be 'F2'
09/12/2024	3.29.0	CRX.002.029	UPDATE	Definition	A code to indicate what type of payment is covered in this claim.For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.
09/12/2024	3.29.0	CRX.002.029	UPDATE	Coding requirement	1. Value must be in Type of Claim List (VVL)2. Value must be 1 character3. Mandatory4. When value equals 'Z', claim denied indicator must equal '0'	1. Value must be in Type of Claim List (VVL)2. Value must be 1 character3. Mandatory4. When value equals "Z", claim denied indicator must equal "0"
09/12/2024	3.29.0	CRX.002.028	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Total Medicaid Paid Amount4. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Total Medicaid Paid Amount4. Mandatory
09/12/2024	3.29.0	CRX.002.027	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value should be on or before End of Time Period value found in associated T-MSIS File Header Record4. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value should be on or before End of Time Period value found in associated T-MSIS File Header Record4. Mandatory
09/12/2024	3.29.0	CRX.002.024	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Conditional5. When value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Conditional5. When value equals "0", is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated
09/12/2024	3.29.0	CRX.002.023	UPDATE	Coding requirement	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service)5. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported.6. Conditional	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in [01,02,04,08,09,10] for the same time period (by date of service)5. If the Type of Claim value is in [1,3,A,C], then value is mandatory and must be reported6. Conditional
03/14/2025	3.35.0	CRX.002.021	UPDATE	Necessity	Mandatory	Conditional
03/14/2025	3.35.0	CRX.002.021	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Mandatory	1. Value must be 12 characters or less2. Conditional
09/12/2024	3.29.0	CRX.002.020	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [‘4’, ‘1’] then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1] then value must be populated
09/12/2024	3.29.0	CRX.001.011	UPDATE	Coding requirement	1. For production files, value must be equal to 'P'2. Value must be in File Status Indicator List (VVL)3. Value must be 1 character4. Mandatory	1. For production files, value must be equal to "P"2. Value must be in File Status Indicator List (VVL)3. Value must be 1 character4. Mandatory
09/12/2024	3.29.0	CRX.001.006	UPDATE	Coding requirement	1. Value must equal 'CLAIM-RX'2. Mandatory	1. Value must equal "CLAIM-RX"2. Mandatory
09/12/2024	3.29.0	COT.003.234	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1]3. Mandatory	1. Value must be 1 character2. Value must be in [0,1]3. Mandatory
09/12/2024	3.29.0	COT.003.225	UPDATE	Coding requirement	1. Value may include up to 8 digits to the left of the decimal point, and 3 digits to the right e.g. 12345678.9992. Conditional	1. Value may include up to 8 digits to the left of the decimal point and 3 digits to the right e.g. 12345678.9992. Conditional
09/12/2024	3.29.0	COT.003.224	UPDATE	Coding requirement	1. Value must be in NDC Unit of Measure List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in NDC Unit of Measure List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	COT.003.213	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	COT.003.212	UPDATE	Coding requirement	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '02', then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is "02",then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less
09/12/2024	3.29.0	COT.003.211	UPDATE	Coding requirement	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is '01', then a valid value is mandatory and must be reported5. If value is in ['14', '35', '42' or '44'], then Sex (ELG.002.023) must not equals 'M'6. If XXI MBESCBES Category of Service is populated then must not be populated	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is "01",then a valid value is mandatory and must be reported5. If value is in [14,35,42,44],then Sex (ELG.002.023) must not equals "M"6. If XXI MBESCBES Category of Service is populated then must not be populated
09/12/2024	3.29.0	COT.003.210	UPDATE	Coding requirement	1. Value must be in CMS 64 Category for Federal Reimbursement List (VVL)2. Value must be 2 characters3. (Federal Funding under Title XXI) if value equals '02', then the eligible's CHIP Code (ELG.003.054) must be in ['2', '3']4. (Federal Funding under Title XIX) if value equals '01' then the eligible's CHIP Code (ELG.003.054) must be '1'5. Conditional6. If Type of Claim is in ['1','2','5','A','B','E','U','V','Y'] and the Total Medicaid Paid Amount is populated on the corresponding claim header, then value must be reported.7. If Type of Claim is in ['4','D'] and the Service Tracking Payment Amount on the relevant record is populated, then value must be reported.	1. Value must be in CMS 64 Category for Federal Reimbursement List (VVL)2. Value must be 2 characters3. (Federal Funding under Title XXI) if value equals "02", then the eligibles CHIP Code (ELG.003.054) must be in [2,3]4. (Federal Funding under Title XIX) if value equals "01", then the eligibles CHIP Code (ELG.003.054) must be "1"5. Conditional6. If Type of Claim is in [1,2,5,A,B,E,U,V,Y] and the Total Medicaid Paid Amount is populated on the corresponding claim header,then value must be reported7. If Type of Claim is in [4,D] and the Service Tracking Payment Amount on the relevant record is populated,then value must be reported
09/12/2024	3.29.0	COT.003.198	UPDATE	Coding requirement	1. Value must be in Tooth Surface Code List (VVL)2. Value must be 1 character3. Conditional4. When populated, associated type of service value must be in [013, 029, 035]	1. Value must be in Tooth Surface Code List (VVL)2. Value must be 1 character3. Conditional4. When populated,associated type of service value must be in [013,029,035]
09/12/2024	3.29.0	COT.003.197	UPDATE	Coding requirement	1. Value must be in Tooth Quad Code List (VVL)2. Value must be 2 characters3. Conditional4. When populated, associated type of service value must be in [013, 029, 035]	1. Value must be in Tooth Quad Code List (VVL)2. Value must be 2 characters3. Conditional4. When populated,associated type of service value must be in [013,029,035]
09/12/2024	3.29.0	COT.003.196	UPDATE	Coding requirement	1. Value must be in Tooth Number List (VVL)2. If Tooth Designation System (COT.003.195) is 'JP' value must be found in [1..32][51-82][A..T]or [AS..KS]3. If Tooth Designation System (COT.003.195) is 'JO' value must have 1 digit before and after the decimal (N.N)4. If Tooth Designation System (COT.003.195) is 'JO' value must be a first digit of 1-4 and the decimal must be between 1-85. Value must be 2 characters or less6. Conditional7. When value is in ['A'-'T'], the difference between Ending Date of Service (COT.002.034) and Date of Birth (COT.002.108) is less than 15 years	1. Value must be in Tooth Number List (VVL)2. If Tooth Designation System (COT.003.195) is "JP" value must be found in [1-32][51-82][A-T]or [AS-KS]3. If Tooth Designation System (COT.003.195) is "JO" value must have 1 digit before and after the decimal (N.N)4. If Tooth Designation System (COT.003.195) is "JO" value must be a first digit of 1-4 and the decimal must be between 1-85. Value must be 2 characters or less6. Conditional7. When value is in [A-T], the difference between Ending Date of Service (COT.002.034) and Date of Birth (COT.002.108) is less than 15 years
09/12/2024	3.29.0	COT.003.193	UPDATE	Coding requirement	1. Value must be in Provider Specialty List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Provider Specialty List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	COT.003.192	UPDATE	Coding requirement	1. Value must be in Provider Type Code List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Provider Type Code List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	COT.003.188	UPDATE	Coding requirement	1. Value must be in HCBS Taxonomy Code List (VVL).2. Value must be 5 characters or less3. Conditional	1. Value must be in HCBS Taxonomy Code List (VVL)2. Value must be 5 characters or less3. Conditional
09/12/2024	3.29.0	COT.003.187	UPDATE	Coding requirement	1. Value must be in HCBS Service Code List (VVL).2. Value must be 1 character3. If value is 1-7, then HCBS Taxonomy must be populated.4. Conditional	1. Value must be in HCBS Service Code List (VVL)2. Value must be 1 character3. If value is in [1-7], then HCBS Taxonomy must be populated4. Conditional
09/12/2024	3.29.0	COT.003.186	UPDATE	Coding requirement	1. Value must be 3 characters2. Mandatory3. When value is in [119-122], Servicing Provider NPI Num (COT.002.190) should not be populated4. Value must be in ['002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '127', '131', '134', '135', '136', '137', '138', '139', '140', '141', '142', '143', '144', '145', '147']5. When value is in [119-122], Servicing Provider Taxonomy (COT.003.191) should not be populated6. When value is in [119-122], Referring Provider NPI Num (COT.002.118) should not be populated7. Value must be 3 characters8. Mandatory9. When value is in [119-122], Billing Provider NPI Num (COT.002.113) should not be populated10. When value is in [119-122], Billing Provider Taxonomy (COT.002.114) should not be populated11. When value is in [119-122], Referring Provider Taxonomy (COT.002.119) should not be populated12. When value is not in ['025','085'], Sex (ELG.002.023) equals 'M'13. When value is in [119-122], Servicing Provider Num (COT.002.189) should not be populated	1. Value must be 3 characters2. Mandatory3. When value is in [119-122],Servicing Provider NPI Num (COT.002.190) should not be populated4. Value must be in [002,003,004,005,006,007,008,010,011,012,013,014,015,016,017,018,019,020,021,022,023,024,025,026,027,028,029,030,031,032,035,036,037,038,039,040,041,042,043,049,050,051,052,053,054,055,056,057,058,060,061,062,063,064,065,066,067,068,069,070,071,072,073,074,075,076,077,078,079,080,081,082,083,084,085,086,087,088,089,115,119,120,121,122,127,131,134,135,136,137,138,139,140,141,142,143,144,145,147]5. When value is in [119-122], Servicing Provider Taxonomy (COT.003.191) should not be populated6. When value is in [119-122], Referring Provider NPI Num (COT.002.118) should not be populated7. Value must be 3 characters8. When value is in [119-122], Billing Provider NPI Num (COT.002.113) should not be populated9. When value is in [119-122], Billing Provider Taxonomy (COT.002.114) should not be populated10. When value is in [119-122], Referring Provider Taxonomy (COT.002.119) should not be populated11. When value is not in [025,085], Sex (ELG.002.023) equals "M"12. When value is in [119-122], Servicing Provider Num (COT.002.189) should not be populated
09/12/2024	3.29.0	COT.003.184	UPDATE	Coding requirement	1. Value may include up to 8 digits to the left of the decimal point, and 3 digits to the right e.g. 12345678.9992. Conditional	1. Value may include up to 8 digits to the left of the decimal point and 3 digits to the right e.g. 12345678.9992. Conditional
09/12/2024	3.29.0	COT.003.183	UPDATE	Coding requirement	1. Value may include up to 8 digits to the left of the decimal point, and 3 digits to the right e.g. 12345678.9992. Conditional3. If Type of Claim is in [1, 3, A, C, U, W], then this value must be reported.4. When populated, corresponding Unit of Measure must be populated	1. Value may include up to 8 digits to the left of the decimal point and 3 digits to the right e.g. 12345678.9992. Conditional3. If Type of Claim is in [1,3,A,C,U,W], then this value must be reported4. When populated,corresponding Unit of Measure must be populated
09/12/2024	3.29.0	COT.003.182	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is "0", then the value must not be populated.4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value is "0", then the value must not be populated4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"
09/12/2024	3.29.0	COT.003.179	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim value equals '3, C, W', then value is mandatory and must be provided4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Type of Claim value equals [3,C,W],then value is mandatory and must be provided4. Conditional
09/12/2024	3.29.0	COT.003.178	UPDATE	Definition	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	COT.003.178	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional4. Value should not be populated or equal to zero, when associated Claim Line Status is in ['26', '026', '87', '087', '542', '585', '654']	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional4. Value should not be populated or equal to zero,when associated Claim Line Status is in [26,026,87,087,542,585,654]
09/12/2024	3.29.0	COT.003.177	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	COT.003.176	UPDATE	Coding requirement	1. Situational2. Value must be between -99999999999.99 and 99999999999.993. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )4. Value must be 11 digits or less left of the decimal i.e. 9999999999 99	1. Situational2. Value must be between -99999999999.99 and 99999999999.993. Value must be expressed as a number with 2-digit precision (e.g. 100.50)4. Value must be 11 digits or less left of the decimal i.e. 9999999999 99
09/12/2024	3.29.0	COT.003.175	UPDATE	Definition	The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity allowed at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity allowed at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	COT.003.175	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional4. When Type of Claim is in ['1', 'A'}, Medicaid Paid Amount (COT.003.177) is less than or equal to the value submitted	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional4. When Type of Claim is in [1,A], Medicaid Paid Amount (COT.003.177) is less than or equal to the value submitted
09/12/2024	3.29.0	COT.003.174	UPDATE	Definition	The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	COT.003.174	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	COT.003.173	UPDATE	Coding requirement	Not Applicable
09/12/2024	3.29.0	COT.003.171	UPDATE	Coding requirement	1. When populated, there must be a corresponding Procedure Code2. Value must be in Procedure Code Flag List (VVL)3. Value must be 2 characters4. Conditional	1. When populated,there must be a corresponding Procedure Code2. Value must be in Procedure Code Flag List (VVL)3. Value must be 2 characters4. Conditional
09/12/2024	3.29.0	COT.003.168	UPDATE	Coding requirement	1. Value must be in Revenue Code List (VVL)2. A Revenue Code value requires an associated Revenue Charge3. Value must be 4 characters or less4. Conditional	1. Value must be in Revenue Code List (VVL)2. When Source Location does not equal “23”, value requires an associated Revenue Charge3. Value must be 4 characters or less4. Conditional5. When populated, Type of Bill must be populated
09/12/2024	3.29.0	COT.003.167	UPDATE	Definition	For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, the date on which the service covered by this claim ended. For capitation premium payments, the date on which the period of coverage related to this payment ends/ended. For financial transactions reported to the OT file, populate with the last day of the time period covered by this financial transaction.For sub-capitation payments, this represents the last date of the period the sub-capitation payment covers.	For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, the date on which the service covered by this claim ended. For capitation premium payments, the date on which the period of coverage related to this payment ends/ended. For financial transactions reported to the OT file, populate with the last day of the time period covered by this financial transaction. For sub-capitation payments, this represents the last date of the period the sub-capitation payment covers.
09/12/2024	3.29.0	COT.003.167	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated End of Time Period value4. Value must be greater than or equal to associated Beginning Date of Service value5. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be equal to or greater than associated Date of Birth (ELG.002.024) value8. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated End of Time Period value4. Value must be greater than or equal to associated Beginning Date of Service value5. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be equal to or greater than associated Date of Birth (ELG.002.024) value8. Mandatory
09/12/2024	3.29.0	COT.003.166	UPDATE	Definition	For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, this would be the date on which the service covered by this claim began. For capitation premium payments, the date on which the period of coverage related to this payment began. For financial transactions reported to the OT file, populate with the first day of the time period covered by this financial transaction.For sub-capitation payments, this represents the first date of the period the sub-capitation payment covers.	For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, this would be the date on which the service covered by this claim began. For capitation premium payments, the date on which the period of coverage related to this payment began. For financial transactions reported to the OT file, populate with the first day of the time period covered by this financial transaction. For sub-capitation payments, this represents the first date of the period the sub-capitation payment covers.
09/12/2024	3.29.0	COT.003.166	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated End of Time Period value4. Value must be less than or equal to associated Ending Date of Service value5. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be less than or equal to at least one of the eligible's Enrollment End Date (ELG.021.254) values8. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated End of Time Period value4. Value must be less than or equal to associated Ending Date of Service value5. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be less than or equal to at least one of the eligibles Enrollment End Date (ELG.021.254) values8. Mandatory
09/12/2024	3.29.0	COT.003.165	UPDATE	Coding requirement	1. Value must be in Claim Status List (VVL)2. Value must be 3 characters or less3. Conditional4. If value in [545, 585, 654], then Claim Denied Indicator must be '0' and Claim Status Category must be 'F2'	1. Value must be in Claim Status List (VVL)2. Value must be 3 characters or less3. Conditional4. If value in [545,585,654],then Claim Denied Indicator must be 0 and Claim Status Category must be "F2"
09/12/2024	3.29.0	COT.003.162	UPDATE	Coding requirement	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [1,3,5,A,C,E,U,W,Y], then value must be in [0,1,4]3. If associated Type of Claim value is in [4,D,X], then value must be in [5,6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated
09/12/2024	3.29.0	COT.003.161	UPDATE	Coding requirement	1. Value must be 3 characters or less2. If associated Line Adjustment Indicator value is 0, then value must not be populated3. If associated Line Adjustment Indicator value is 1, then value is mandatory and must be provided4. Conditional5. When populated, value must be one or greater	1. Value must be 3 characters or less2. If associated Line Adjustment Indicator value is "0", then value must not be populated3. If associated Line Adjustment Indicator value is "1", then value is mandatory and must be provided4. Conditional5. When populated,value must be one or greater
09/12/2024	3.29.0	COT.003.160	UPDATE	Coding requirement	1. Value must be 3 characters or less2. Value must not contain a pipe or asterisk symbols3. Mandatory4. When populated, value must be one or greater	1. Value must be 3 characters or less2. Value must not contain a pipe or asterisk symbols3. Mandatory4. When populated,value must be one or greater
09/12/2024	3.29.0	COT.003.159	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [‘4’, ‘1’] then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
09/12/2024	3.29.0	COT.003.157	UPDATE	Definition	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual (except on service tracking payments). Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique "key" value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47572	A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual (except on service tracking payments). Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, 'CMS Guidance: Reporting Shared MSIS Identification Numbers' for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47572
09/12/2024	3.29.0	COT.003.157	UPDATE	Coding requirement	1. Mandatory2. Value must be 20 characters or less3. When Type of Claim (COT.002.037) equals 4, D or X (lump sum payment) value must begin with an '&'	1. Mandatory2. Value must be 20 characters or less3. When Type of Claim (COT.002.037) is in [4,D,X] (lump sum payment) value must begin with an "&"
09/12/2024	3.29.0	COT.002.233	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	COT.002.232	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	COT.002.231	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	COT.002.230	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	COT.002.229	UPDATE	Definition	The NPI of Ordering Provider represents the individual who requested the service or items being reported on this service line. Example include, but are not limited to, provider ordering diagnostic tests and medical equipment or supplies.[Ordering provider information is only captured at the line level in the X12 837P format but in v3.0.0 of the T-MSIS file layout it is only captured at the header level. This discrepancy will be addressed in a future version of the T-MSIS OT file layout. Until Ordering provider information has been moved from the T-MSIS claim header to the line, there is no need to report it at the header.]	The NPI of Ordering Provider represents the individual who requested the service or items being reported on this service line. Example include, but are not limited to, provider ordering diagnostic tests and medical equipment or supplies. [Ordering provider information is only captured at the line level in the X12 837P format but in v3.0.0 of the T-MSIS file layout it is only captured at the header level. This discrepancy will be addressed in a future version of the T-MSIS OT file layout. Until Ordering provider information has been moved from the T-MSIS claim header to the line, there is no need to report it at the header.]
09/12/2024	3.29.0	COT.002.229	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2'3. Conditional4. Value must exist in the NPPES NPI data file	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to "2"3. Conditional4. Value must exist in the NPPES NPI data file
09/12/2024	3.29.0	COT.002.150	UPDATE	Coding requirement	Not Applicable
09/12/2024	3.29.0	COT.002.147	UPDATE	Coding requirement	1. Conditional2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S, L, O, I, B, Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S, L, O, I, B, Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)11. Character 9 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols	1. Conditional2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols
09/12/2024	3.29.0	COT.002.146	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Service (COT.003.186) equals '121', value must not be populated5. Value must exist in the NPPES NPI data file	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. When Type of Service (COT.003.186) equals "121", value must not be populated5. Value must exist in the NPPES NPI data file
09/12/2024	3.29.0	COT.002.142	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Situational	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
09/12/2024	3.29.0	COT.002.140	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Situational	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
09/12/2024	3.29.0	COT.002.138	UPDATE	Coding requirement	1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Conditional4. Value must be populated when an associated Type of Service (COT.003.186) equals ‘138’ (payment for health home services)5. Value must be populated when an associated claim line has a XIX MBESCBES Category of Service (COT.003.211) equals ‘45’ (health homes for substance use services)	1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Conditional4. Value must be populated when an associated Type of Service (COT.003.186) equals "138" (payment for health home services)5. Value must be populated when an associated claim line has a XIX MBESCBES Category of Service (COT.003.211) equals "45" (health homes for substance use services)
09/12/2024	3.29.0	COT.002.137	UPDATE	Coding requirement	1. Value must be in Copayment Waived Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1]4. Situational	1. Value must be in Copayment Waived Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1]4. Situational
09/12/2024	3.29.0	COT.002.136	UPDATE	Coding requirement	1. Value must be in Claim Denied Indicator List (VVL)2. If value is '0', then Claim Status Category must equal "F2"3. Value must be 1 character4. Mandatory	1. Value must be in Claim Denied Indicator List (VVL)2. If value is "0", then Claim Status Category must equal "F2"3. Value must be 1 character4. Mandatory
09/12/2024	3.29.0	COT.002.134	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	COT.002.132	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	COT.002.130	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	COT.002.128	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Border State Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Border State Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	COT.002.123	UPDATE	Coding requirement	1. Value must be in Place of Service Code List (VVL)2. Value must be 2 characters3. Conditional4. If value is populated on a non-denied claim, then Procedure Code (COT.003.169) must be populated.5. When Type of Service (COT.003.186) is in [119-122], Place of Service (COT.002.123) should not be populated	1. Value must be in Place of Service Code List (VVL)2. Value must be 2 characters3. Conditional4. If value is populated on a non-denied claim, then Procedure Code (COT.003.169) must be populated5. When Type of Service (COT.003.186) is in [119-122], value should not be populated
09/12/2024	3.29.0	COT.002.122	UPDATE	Coding requirement	1. Conditional2. Value must be 12 characters or less3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value = "00", then value must not be populated.5. Value must be populated when Crossover Indicator (COT.002.023) equals '1' and Medicare Beneficiary Identifier (COT.002.147) is not populated.	1. Conditional2. Value must be 12 characters or less3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value equals "00", then value must not be populated5. Value must be populated when Crossover Indicator (COT.002.023) equals "1" and Medicare Beneficiary Identifier (COT.002.147) is not populated
09/12/2024	3.29.0	COT.002.118	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Value must be in the NPPES NPI data file4. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must be in the NPPES NPI data file4. Conditional
09/12/2024	3.29.0	COT.002.116	UPDATE	Coding requirement	1. Value must be in Provider Specialty List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Provider Specialty List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	COT.002.115	UPDATE	Coding requirement	1. Value must be in Provider Type Code List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Provider Type Code List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	COT.002.114	UPDATE	Coding requirement	1. Value must be in Provider Taxonomy List (VVL)2. Value must be 12 characters or less3. Conditional4. Value is in [119, 120, 121, 122 ], then value should not be populated	1. Value must be in Provider Taxonomy List (VVL)2. Value must be 12 characters or less3. Conditional4. If Type of Service (COT.003.186) is in [119,120,121,122], then value should not be populated
09/12/2024	3.29.0	COT.002.113	UPDATE	Definition	The National Provider ID (NPI) of the billing entity responsible for billing a patient for healthcare services. The billing provider can also be servicing, referring, or prescribing provider. Can be admitting provider except for Long Term Care.For sub-capitation payments, report the national provider identifier (NPI) for the sub-capitated entity if the provider has one.	The National Provider ID (NPI) of the billing entity responsible for billing a patient for healthcare services. The billing provider can also be servicing, referring, or prescribing provider. Can be admitting provider except for Long Term Care. For sub-capitation payments, report the national provider identifier (NPI) for the sub-capitated entity if the provider has one.
09/12/2024	3.29.0	COT.002.113	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Claim (COT.002.037) not in ('3','C','W') then value must match Provider Identifier (PRV.002.081)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When Type of Claim (COT.002.037) not in [3,C,W] then value must match Provider Identifier (PRV.002.081)6. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal '01'7. NPPES Entity Type Code associated with this NPI must equal ‘2’ (Organization)
09/12/2024	3.29.0	COT.002.112	UPDATE	Definition	A unique identification number assigned by the state to a provider or capitation plan. This data element should represent the entity billing for the service. For encounter records, if associated Type of Claim value equals 3, C, or W, then value must be the state identifier of the provider or entity (billing or reporting) to the managed care plan.For sub-capitation payments, report the state-assigned provider identifier for the sub-capitated entity, when available or required.	A unique identification number assigned by the state to a provider or capitation plan. This data element should represent the entity billing for the service. For encounter records, if associated Type of Claim value equals 3, C, or W, then value must be the state identifier of the provider or entity (billing or reporting) to the managed care plan. For sub-capitation payments, report the state-assigned provider identifier for the sub-capitated entity, when available or required.
09/12/2024	3.29.0	COT.002.112	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.081) equal to '1' 5. When Type of Claim is in ['1','3','A','C'], then value must be populated6. When Type of Claim in ('1','3','A','C’) then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in ['01', '02', '03', '04', '05', '06'] (active)7. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)9. When Type of Service (COT.003.186) is not in ['119', ‘120’, ‘122’], value must be reported in Provider Identifier (PRV.005.080) with an associated Provider Identifier Type (PRV.005.081) equal to '1'	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [Z,3,C,W,2,B,V,4,D,X] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [Z,3,C,W,2,B,V,4,D,X] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.081) equal to "1"5. When Type of Claim is in [1,3,A,C], then value must be populated6. When Type of Claim is in [1,3,A,C] then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in [01,02,03,04,05,06] (active)7. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)9. When Type of Service (COT.003.186) is not in [119,120,122], value must be reported in Provider Identifier (PRV.005.080) with an associated Provider Identifier Type (PRV.005.081) equal to "1"
09/12/2024	3.29.0	COT.002.111	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by a version number [0-9] in the 12th position 5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be "01" or in [21-30](1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Conditional
09/12/2024	3.29.0	COT.002.110	UPDATE	Coding requirement	1. Value must be in Waiver Type List (VVL)2. Value must be 2 characters3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. When populated, Waiver ID (COT.002.111) must be populated5. Conditional6. Value must be in [ '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20', '33'] when associated Program Type equals "07"	1. Value must be in Waiver Type List (VVL)2. Value must be 2 characters3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. When populated, Waiver ID (COT.002.111) must be populated5. Conditional6. Value must be in [06,07,08,09,10,11,12,13,14,15,16,17,18,19,20, 33] when associated Program Type equals "07"
09/12/2024	3.29.0	COT.002.109	UPDATE	Coding requirement	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Conditional	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Conditional
09/12/2024	3.29.0	COT.002.104	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Conditional	1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional
02/27/2025	3.34.0	COT.002.083	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	COT.002.082	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	COT.002.081	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	COT.002.080	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	COT.002.079	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	COT.002.078	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	COT.002.077	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	COT.002.076	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	COT.002.075	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	COT.002.074	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
09/12/2024	3.29.0	COT.002.073	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Healthcare Acquired Condition Indicator List (VVL).4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Healthcare Acquired Condition Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	COT.002.072	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Forced Claim Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Forced Claim Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	COT.002.069	UPDATE	Coding requirement	1. Value must be in Medicare Reimbursement Type List (VVL)2. Value is mandatory and must be provided, when Crossover Indicator is equal to '1' (Crossover Claim)3. Value must be 2 characters4. Conditional	1. Value must be in Medicare Reimbursement Type List (VVL)2. Value is mandatory and must be provided, when Crossover Indicator is equal to "1" (Crossover Claim)3. Value must be 2 characters4. Conditional
09/12/2024	3.29.0	COT.002.068	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level.For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only.For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
09/12/2024	3.29.0	COT.002.066	UPDATE	Definition	A unique number assigned by the state which represents a distinct comprehensive managed care plan, prepaid health plan, primary care case management program, a program for all-inclusive care for the elderly entity, or other approved plans.For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report the PLAN-ID-NUMBER for the MCP (MCO, PIHP, or PAHP that has a contract with a state) that is making the payment to the sub-capitated entity or sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	A unique number assigned by the state which represents a distinct comprehensive managed care plan, prepaid health plan, primary care case management program, a program for all-inclusive care for the elderly entity, or other approved plans. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report the PLAN-ID-NUMBER for the MCP (MCO, PIHP, or PAHP that has a contract with a state) that is making the payment to the sub-capitated entity or sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	COT.002.066	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional4. Value must match Managed Care Plan ID (ELG.014.192)5. Value must match State Plan ID Number (MCR.002.019)6. When Type of Claim (COT.002.037) in (3, C, W, 2, B, V) value must have a managed care enrollment (ELG.014) for the beneficiary where the Beginning DOS (COT.002.033) occurs between the managed care plan enrollment eff/end dates (ELG.014.197/198)7. When Type of Claim (COT.002.037) in (3, C, W, 2, B, V) value must have a managed care main record (MCR.002) for the plan where the Beginning DOS (COT.002.033) occurs between the managed care contract eff/end dates (MCR.002.020/021)	1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional4. Value must match Managed Care Plan ID (ELG.014.192)5. Value must match State Plan ID Number (MCR.002.019)6. When Type of Claim (COT.002.037) in [3,C,W,2,B,V] value must have a managed care enrollment (ELG.014) for the beneficiary where the Beginning DOS (COT.002.033) occurs between the managed care plan enrollment eff/end dates (ELG.014.197/198)7. When Type of Claim (COT.002.037) in (3,C,W,2,B,V) value must have a managed care main record (MCR.002) for the plan where the Beginning DOS (COT.002.033) occurs between the managed care contract eff/end dates (MCR.002.020/021)
09/12/2024	3.29.0	COT.002.065	UPDATE	Coding requirement	1. Value must be in Program Type List (VVL)2. Value must be 2 characters3. Mandatory4. (Community First Choice) If value equals '11', then State Plan Option Type (ELG.011.163) must equal '01' for the same time period5. If value equals '13', then State Plan Option Type (ELG.011.163) must equal '02' for the same time period	1. Value must be in Program Type List (VVL)2. Value must be 2 characters3. Mandatory4. (Community First Choice) If value equals "11", then State Plan Option Type (ELG.011.163) must equal "01" for the same time period5. If value equals "13", then State Plan Option Type (ELG.011.163) must equal "02" for the same time period
09/12/2024	3.29.0	COT.002.064	UPDATE	Coding requirement	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If value equals '1', then Total Medicare Coinsurance amount must not be populated.5. If value equals '0', then Crossover Indicator must equals '0'6. If value equals '1', then Crossover Indicator must equals '1'7. Conditional	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. If value equals "1", then Total Medicare Coinsurance amount must not be populated5. If value equals "0", then Crossover Indicator must equals "0"6. If value equals "1", then Crossover Indicator must equal "1"7. Conditional
09/12/2024	3.29.0	COT.002.063	UPDATE	Coding requirement	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Value must be populated if Type of Claim is not in [3,C,W,6]4. Conditional
09/12/2024	3.29.0	COT.002.062	UPDATE	Coding requirement	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Value must be populated if Type of Claim is not in [3,C,W,6]4. Conditional
09/12/2024	3.29.0	COT.002.061	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Fixed Payment Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Fixed Payment Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	COT.002.060	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim value is in [4, D, or X], then value is mandatory and must be provided4. Conditional5. When populated, Service Tracking Type must be populated6. When populated, Total Medicaid Amount must not be populated	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Type of Claim value is in [4,D,X]], then value is mandatory and must be provided4. Conditional5. When populated, Service Tracking Type must be populated6. When populated, Total Medicaid Amount must not be populated
09/12/2024	3.29.0	COT.002.059	UPDATE	Coding requirement	1. Value must be in Service Tracking Type List (VVL)2. (Service Tracking Claim) if associated Type of Claim is in ['4','D', 'X'] then value is mandatory and must be reported3. Value must be 2 characters4. Conditional	1. Value must be in Service Tracking Type List (VVL)2. (Service Tracking Claim) if associated Type of Claim is in [4,D,X] then value is mandatory and must be reported3. Value must be 2 characters4. Conditional
09/12/2024	3.29.0	COT.002.057	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	COT.002.056	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	COT.002.054	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than associated Total Billed Amount- (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount- (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional
09/12/2024	3.29.0	COT.002.053	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is '0' (not a crossover claim), then value should not be populated.4. Conditional5. If associated Medicare Combined Deductible Indicator is '1', then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value is "0" (not a crossover claim), then value should not be populated4. Conditional5. If associated Medicare Combined Deductible Indicator is "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount
09/12/2024	3.29.0	COT.002.052	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is '0' (not a crossover claim), then value should not be populated.4. Conditional5. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value is "0" (not a crossover claim), then value should not be populated4. Conditional5. When populated, value must be less than or equal to Total Billed Amount
09/12/2024	3.29.0	COT.002.050	UPDATE	Definition	The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.For sub-capitation payments, this represents the amount paid by the managed care plan to the sub-capitated entity.	The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field. For sub-capitation payments, this represents the amount paid by the managed care plan to the sub-capitated entity.
09/12/2024	3.29.0	COT.002.050	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must be populated, when Type of Claim is in [‘1’, ‘A’]8. Value must not be populated or equal to ‘0.00’ when associated Claim Status is in ['26', '026', '87', '087', '542', '585', '654']9. Value should not be populated, when associated Type of Claim value is in [‘4’, ‘D’] 10. Value must not be greater than Total Allowed Amount (COT.002.049) 11. Value must be populated, when Type of Claim (COT.002.037) is in [‘2’, '5', ‘B’, 'E']	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must be populated, when Type of Claim is in [1,A]8. Value must not be populated or equal to ‘0.00’ when associated Claim Status is in [26,026,87,087,542,585,654]9. Value should not be populated, when associated Type of Claim value is in [4,D]10. Value must not be greater than Total Allowed Amount (COT.002.049)11. Value must be populated, when Type of Claim (COT.002.037) is in [2,5,B,E]
09/12/2024	3.29.0	COT.002.049	UPDATE	Definition	The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity allowed for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The claim header level maximum amount determined by the payer as being "allowable" under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state"s MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity allowed for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	COT.002.049	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. When populated and Payment Level Indicator = '2' then value must equal the sum of all claim line Allowed Amount values4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. When populated and Payment Level Indicator equals "2" then value must equal the sum of all claim line Allowed Amount values4. Conditional
09/12/2024	3.29.0	COT.002.048	UPDATE	Definition	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	COT.002.048	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. When associated Type of Claim in [‘1’, ’3’, ’A’, ’C’], value must be populated	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. When associated Type of Claim in [1,3,A,C] and Source Location does not equal "23", value must be populated
09/12/2024	3.29.0	COT.002.041	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.For sub-capitation payments, report a SOURCE-LOCATION of '20', indicating the managed care plan is the source of payment.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = "22" to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = "23" to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitation payments, report a SOURCE-LOCATION of "20", indicating the managed care plan is the source of payment.
09/12/2024	3.29.0	COT.002.040	UPDATE	Coding requirement	1. Value must be in Claim Status Category List (VVL)2. (Denied Claim) if associated Claim Denied Indicator indicates the claim was denied, then value must be "F2"3. (Denied Claim) if associated Claim Status is in [ 542, 585, 654 ], then value must be "F2"4. Value must be 3 characters or less5. Mandatory	1. Value must be in Claim Status Category List (VVL)2. (Denied Claim) if associated Claim Denied Indicator indicates the claim was denied, then value must be "F2"3. (Denied Claim) if associated Claim Status is in [542,585,654], then value must be "F2"4. Value must be 3 characters or less5. Mandatory
09/12/2024	3.29.0	COT.002.039	UPDATE	Coding requirement	1. Value must be in Claim Status List (VVL)2. Value must be 3 characters or less3. Conditional4. If value in [ 542, 585, 654 ], Claim Denied Indicator must be '0' and Claim Status Category must be 'F2'	1. Value must be in Claim Status List (VVL)2. Value must be 3 characters or less3. Conditional4. If value in [542,585,654], Claim Denied Indicator must be "0" and Claim Status Category must be "F2"
09/12/2024	3.29.0	COT.002.038	UPDATE	Coding requirement	1. Value must be in Type of Bill List (VVL)2. Value must be 4 characters3. First character must be a '0'4. Conditional	1. Value must be in Type of Bill List (VVL)2. Value must be 4 characters3. First character must be a "0"4. Conditional5. When populated, Revenue Code must be populated
09/12/2024	3.29.0	COT.002.037	UPDATE	Definition	A code to indicate what type of payment is covered in this claim.For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.For sub-capitation payments, report TYPE-OF-CLAIM = '6' or “F”.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record. For sub-capitation payments, report TYPE-OF-CLAIM = "6" or “F”.
09/12/2024	3.29.0	COT.002.037	UPDATE	Coding requirement	1. Value must be in Type of Claim List (VVL)2. Value must be 1 character3. Mandatory4. When value equals 'Z', claim denied indicator must equal '0'	1. Value must be in Type of Claim List (VVL)2. Value must be 1 character3. Mandatory4. When value equals "Z", claim denied indicator must equal "0"
09/12/2024	3.29.0	COT.002.034	UPDATE	Definition	For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, the date on which the service covered by this claim ended. For capitation premium payments, the date on which the period of coverage related to this payment ends/ended. For financial transactions reported to the OT file, populate with the last day of the time period covered by this financial transaction.For sub-capitation payments, this represents the last date of the period the sub-capitation payment covers.	For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, the date on which the service covered by this claim ended. For capitation premium payments, the date on which the period of coverage related to this payment ends/ended. For financial transactions reported to the OT file, populate with the last day of the time period covered by this financial transaction. For sub-capitation payments, this represents the last date of the period the sub-capitation payment covers.
09/12/2024	3.29.0	COT.002.034	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated End of Time Period value4. Value must be greater than or equal to associated Beginning Date of Service value5. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be equal to or greater than associated Date of Birth (ELG.002.024) value8. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated End of Time Period value4. Value must be greater than or equal to associated Beginning Date of Service value5. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be equal to or greater than associated Date of Birth (ELG.002.024) value8. Mandatory
09/12/2024	3.29.0	COT.002.033	UPDATE	Definition	For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, this would be the date on which the service covered by this claim began. For capitation premium payments, the date on which the period of coverage related to this payment began. For financial transactions reported to the OT file, populate with the first day of the time period covered by this financial transaction.For sub-capitation payments, this represents the first date of the period the sub-capitation payment covers.	For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, this would be the date on which the service covered by this claim began. For capitation premium payments, the date on which the period of coverage related to this payment began. For financial transactions reported to the OT file, populate with the first day of the time period covered by this financial transaction. For sub-capitation payments, this represents the first date of the period the sub-capitation payment covers.
09/12/2024	3.29.0	COT.002.033	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated End of Time Period value4. Value must be less than or equal to associated Ending Date of Service value5. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be less than or equal to at least one of the eligible's Enrollment End Date (ELG.021.254) values8. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated End of Time Period value4. Value must be less than or equal to associated Ending Date of Service value5. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be less than or equal to at least one of the eligible's Enrollment End Date (ELG.021.254) values8. Mandatory
09/12/2024	3.29.0	COT.002.024	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Conditional5. When value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Conditional5. When value equals "0", is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated
09/12/2024	3.29.0	COT.002.023	UPDATE	Coding requirement	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service)5. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported.6. Conditional	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in [01,02,04,08,09,10] for the same time period (by date of service)5. If the Type of Claim value is in [1,3,A,C], then value is mandatory and must be reported6. Conditional
09/12/2024	3.29.0	COT.002.022	UPDATE	Coding requirement	1. Mandatory2. Value must be 20 characters or less3. Populated value must begin with an '&', when Type of Claim (COT.002.037) = 4, D or X (lump sum payment)4. Value must match MSIS Identification Number (ELG.021.251) and the Beginning Date of Service (COT.002.033) must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)	1. Mandatory2. Value must be 20 characters or less3. When Type of Claim (COT.002.037) in [4,D,X] (lump sum payment), value must begin with an "'&"4. Value must match MSIS Identification Number (ELG.021.251) and the Beginning Date of Service (COT.002.033) must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)
09/12/2024	3.29.0	COT.002.020	UPDATE	Coding requirement	Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [‘4’, ‘1’] then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1] then value must be populated
09/12/2024	3.29.0	COT.001.011	UPDATE	Coding requirement	1. For production files, value must be equal to 'P'2. Value must be in File Status Indicator List (VVL)3. Value must be 1 character4. Mandatory	1. For production files, value must be equal to "P"2. Value must be in File Status Indicator List (VVL)3. Value must be 1 character4. Mandatory
09/12/2024	3.29.0	COT.001.006	UPDATE	Coding requirement	1. Value must equal 'CLAIM-OT'2. Mandatory	1. Value must equal "CLAIM-OT"2. Mandatory
09/12/2024	3.29.0	CLT.003.243	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1]3. Mandatory	1. Value must be 1 character2. Value must be in [0,1]3. Mandatory
09/12/2024	3.29.0	CLT.003.229	UPDATE	Coding requirement	1. Value must be in NDC Unit of Measure List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in NDC Unit of Measure List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CLT.003.225	UPDATE	Coding requirement	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '02', then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is "02", then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less
09/12/2024	3.29.0	CLT.003.224	UPDATE	Coding requirement	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is '01', then a valid value is mandatory and must be reported5. If value is in ['14', '35', '42' or '44'], then Sex (ELG.002.023) must not equals 'M'6. If XXI MBESCBES Category of Service is populated then must not be populated	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is "01", then a valid value is mandatory and must be reported5. If value is in [14,35,42,44], then Sex (ELG.002.023) must not equal "M"6. If XXI MBESCBES Category of Service is populated, then must not be populated
09/12/2024	3.29.0	CLT.003.219	UPDATE	Coding requirement	1. Value must be in CMS 64 Category for Federal Reimbursement List (VVL)2. Value must be 2 characters3. (Federal Funding under Title XXI) if value equals '02', then the eligible's CHIP Code (ELG.003.054) must be in ['2', '3']4. (Federal Funding under Title XIX) if value equals '01' then the eligible's CHIP Code (ELG.003.054) must be '1'5. Conditional6. If Type of Claim is in ['1','2','5','A','B','E','U','V','Y'] and the Total Medicaid Paid Amount is populated on the corresponding claim header, then value must be reported.7. If Type of Claim is in ['4','D'] and the Service Tracking Payment Amount on the relevant record is populated, then value must be reported.	1. Value must be in CMS 64 Category for Federal Reimbursement List (VVL)2. Value must be 2 characters3. (Federal Funding under Title XXI) if value equals '02', then the eligible's CHIP Code (ELG.003.054) must be in [2,3]4. (Federal Funding under Title XIX) if value equals "01" then the eligible's CHIP Code (ELG.003.054) must be "1"5. Conditional6. If Type of Claim is in [1,2,5,A,B,E,U,V,Y] and the Total Medicaid Paid Amount is populated on the corresponding claim header, then value must be reported7. If Type of Claim is in [4,D] and the Service Tracking Payment Amount on the relevant record is populated, then value must be reported
09/12/2024	3.29.0	CLT.003.216	UPDATE	Coding requirement	1. Value must be in Provider Specialty List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Provider Specialty List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CLT.003.215	UPDATE	Coding requirement	1. Value must be in Provider Type Code List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Provider Type Code List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CLT.003.211	UPDATE	Coding requirement	1. Value must be 3 characters2. Mandatory3. Value must be in ['009', '044', '045', '046', '047', '048', '050', '059', '133', '136', '137', '146', '147']	1. Value must be 3 characters2. Mandatory3. Value must be in [009,044,045,046,047,048,050,059,133,136,137,146,147]
09/12/2024	3.29.0	CLT.003.210	UPDATE	Coding requirement	1. Value must be in Billing Unit List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Billing Unit List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CLT.003.209	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim value equals '3, C, W', then value is mandatory and must be provided4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Type of Claim value is in [3,C,W], then value is mandatory and must be provided4. Conditional
09/12/2024	3.29.0	CLT.003.208	UPDATE	Definition	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CLT.003.208	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional4. Value should not be populated or equal to zero, when associated Claim Line Status is in ['26', '026', '87', '087', '542', '585', '654']	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional4. Value should not be populated or equal to zero, when associated Claim Line Status is in [26,026,87,087,542,585,654]
09/12/2024	3.29.0	CLT.003.207	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CLT.003.206	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CLT.003.205	UPDATE	Definition	The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity allowed at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The maximum amount displayed at the claim line level as determined by the payer as being "allowable" under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state"s MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity allowed at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CLT.003.205	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CLT.003.204	UPDATE	Definition	The total amount billed for the related Revenue Code. Total amount billed includes both covered and non-covered charges (as defined by UB-04 Billing Manual). For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed to the managed care plan.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The total amount billed for the related Revenue Code. Total amount billed includes both covered and non-covered charges (as defined by UB-04 Billing Manual). For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed to the managed care plan. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CLT.003.204	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than or equal to associated Total Billed Amount value.4. When populated, associated claim line Revenue Charge must be populated5. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than or equal to associated Total Billed Amount value4. When populated and the Source Location does not equal “23”, the associated claim line Revenue Code must be populated5. Conditional
09/12/2024	3.29.0	CLT.003.203	UPDATE	Definition	On facility claim entries, this field is to capture maximum allowable quantity by revenue code category, e.g., number of days in a particular type of accommodation, pints of blood, etc. However, when HCPCS codes are required for services, the units are equal to the number of times the procedure/service being reported was performed. This field is only applicable when the service being billed can be quantified in discrete units, e.g., a number of visits or the number of units of a prescription/refill that were filled. For CLAIMOT claims/encounter records use Service Quantity Actual and CLAIMRX claims/encounter records use the Prescription Quantity Actual field	On facility claim entries, this field is to capture maximum allowable quantity by revenue code category, e.g., number of days in a particular type of accommodation, pints of blood, etc. However, when HCPCS codes are required for services, the units are equal to the number of times the procedure/service being reported was performed. This field is only applicable when the service being billed can be quantified in discrete units, e.g., a number of visits or the number of units of a prescription/refill that were filled. For CLAIMOT claims/encounter records use Service Quantity Actual and CLAIMRX claims/encounter records use the Prescription Quantity Actual field.
09/12/2024	3.29.0	CLT.003.202	UPDATE	Definition	On facility claim entries, this field is to capture the actual service quantity by revenue code category, e.g., number of days in a particular type of accommodation, pints of blood, etc. However, when HCPCS codes are required for services, the units are equal to the number of times the procedure/service being reported was performed. For CLAIMOT claims/encounter records use Service Quantity Actual and CLAIMRX claims/encounter records use the Prescription Quantity Actual field	On facility claim entries, this field is to capture the actual service quantity by revenue code category, e.g., number of days in a particular type of accommodation, pints of blood, etc. However, when HCPCS codes are required for services, the units are equal to the number of times the procedure/service being reported was performed. For CLAIMOT claims/encounter records use Service Quantity Actual and CLAIMRX claims/encounter records use the Prescription Quantity Actual field.
09/12/2024	3.29.0	CLT.003.201	UPDATE	Coding requirement	Not Applicable
09/12/2024	3.29.0	CLT.003.198	UPDATE	Coding requirement	1. Value must be in Revenue Code List (VVL)2. A Revenue Code value requires an associated Revenue Charge3. Value must be 4 characters or less4. Mandatory	1. Value must be in Revenue Code List (VVL)2. When Source Location does not equal “23”, value requires an associated Revenue Charge3. Value must be 4 characters or less4. Mandatory
09/12/2024	3.29.0	CLT.003.197	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated End of Time Period value4. Value must be greater than or equal to associated Beginning Date of Service value5. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be equal to or greater than associated Date of Birth (ELG.002.024) value8. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated End of Time Period value4. Value must be greater than or equal to associated Beginning Date of Service value5. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be equal to or greater than associated Date of Birth (ELG.002.024) value8. Mandatory
09/12/2024	3.29.0	CLT.003.196	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated End of Time Period value4. Value must be less than or equal to associated Ending Date of Service value5. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be less than or equal to at least one of the eligible's Enrollment End Date (ELG.021.254) values8. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated End of Time Period value4. Value must be less than or equal to associated Ending Date of Service value5. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be less than or equal to at least one of the eligible's Enrollment End Date (ELG.021.254) values8. Mandatory
09/12/2024	3.29.0	CLT.003.195	UPDATE	Coding requirement	1. Value must be in Claim Status List (VVL)2. Value must be 3 characters or less3. Conditional4. If value in [545, 585, 654], then Claim Denied Indicator must be '0' and Claim Status Category must be 'F2'	1. Value must be in Claim Status List (VVL)2. Value must be 3 characters or less3. Conditional4. If value in [545,585,654], then Claim Denied Indicator must be "1" and Claim Status Category must be "F2"
09/12/2024	3.29.0	CLT.003.192	UPDATE	Coding requirement	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [1,3,5,A,C,E,U,W,Y], then value must be in [0,1,4]3. If associated Type of Claim value is in [4,D,X], then value must be in [5,6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated
09/12/2024	3.29.0	CLT.003.191	UPDATE	Coding requirement	1. Value must be 3 characters or less2. If associated Line Adjustment Indicator value is 0, then value must not be populated3. If associated Line Adjustment Indicator value is 1, then value is mandatory and must be provided4. Conditional5. When populated, value must be one or greater	1. Value must be 3 characters or less2. If associated Line Adjustment Indicator value is "0", then value must not be populated3. If associated Line Adjustment Indicator value is "1", then value is mandatory and must be provided4. Conditional5. When populated, value must be one or greater
09/12/2024	3.29.0	CLT.003.189	UPDATE	Coding requirement	Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [‘4’, ‘1’] then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
09/12/2024	3.29.0	CLT.003.187	UPDATE	Coding requirement	1. Mandatory2. Value must be 20 characters or less3. When Type of Claim (CLT.002.052) equals 4, D or X (lump sum payment) value must begin with an '&'	1. Mandatory2. Value must be 20 characters or less3. When Type of Claim (CLT.002.052) is in [4,D,X] (lump sum payment) value must begin with an "&"
09/12/2024	3.29.0	CLT.002.242	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CLT.002.241	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CLT.002.240	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CLT.002.239	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CLT.002.179	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is "0", then the value must not be populated.4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value is "0", then the value must not be populated4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"
09/12/2024	3.29.0	CLT.002.178	UPDATE	Coding requirement	1. Value must be in Provider Type Code List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Provider Type Code List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CLT.002.176	UPDATE	Coding requirement	1. Value must be in Provider Specialty List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Provider Specialty List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CLT.002.174	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. Value must exist in the NPPES data file	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. Value must exist in the NPPES data file
09/12/2024	3.29.0	CLT.002.168	UPDATE	Coding requirement	1. Conditional2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S, L, O, I, B, Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S, L, O, I, B, Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)11. Character 9 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols	1. Conditional2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols
09/12/2024	3.29.0	CLT.002.167	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2'3. Value must exist in the NPPES NPI data file4. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional
09/12/2024	3.29.0	CLT.002.165	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Situational	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
09/12/2024	3.29.0	CLT.002.163	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Situational	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
09/12/2024	3.29.0	CLT.002.159	UPDATE	Coding requirement	1. Value must be in Claim Denied Indicator List (VVL)2. If value is '0', then Claim Status Category must equal "F2"3. Value must be 1 character4. Mandatory	1. Value must be in Claim Denied Indicator List (VVL)2. If value is "0", then Claim Status Category must equal "F2"3. Value must be 1 character4. Mandatory
09/12/2024	3.29.0	CLT.002.157	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CLT.002.155	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CLT.002.153	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CLT.002.151	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Border State Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Border State Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	CLT.002.149	UPDATE	Coding requirement	1. Value must be numeric2. Value must be 5 digits or less3. Conditional4. When populated, value must be less than or equal to the number of days between (ending date of service minus beginning date of service) plus one day5. (nursing facility) value is required when the Type of Service in [009, 045, 047, 059]6. When populated, if value is greater than zero, then Level of Care Status (ELG.005.088) for the associated MSIS Identification Number (CLT.002.022) must equal '003' (Nursing Facility) for the same month as the begin and end date of service	1. Value must be numeric2. Value must be 5 digits or less3. Conditional4. When populated, value must be less than or equal to the number of days between (ending date of service minus beginning date of service) plus one day5. (nursing facility) value is required when the Type of Service in [009,045,047,059]6. When populated, if value is greater than zero, then Level of Care Status (ELG.005.088) for the associated MSIS Identification Number (CLT.002.022) must equal "003" (Nursing Facility) for the same month as the begin and end date of service
09/12/2024	3.29.0	CLT.002.148	UPDATE	Coding requirement	1. Value must be numeric2. Value must be 5 digits or less3. Conditional4. (Intermediate Care Facility for Individuals with Intellectual Disabilities) value is required when Type of Service (CLT.003.211) in [009, 045, 046, 047, 059]	1. Value must be numeric2. Value must be 5 digits or less3. Conditional4. (Intermediate Care Facility for Individuals with Intellectual Disabilities) value is required when Type of Service (CLT.003.211) in [009,045,046,047,059]
09/12/2024	3.29.0	CLT.002.147	UPDATE	Coding requirement	1. Value must be 5 digits or less2. Conditional3. Value is mandatory when associated Type of Service (CLT.003.211) = '046'4. Value must be less than or equal to the number of days between (ending date of service minus beginning date of service) plus one day5. When populated, if value is greater than 0 and less than 99998, then Level of Care Status (ELG.005.088) for the associated MSIS Identification Number (CLT.002.022) must equal '004' (ICF/IID) for the same month as the begin and end date of service	1. Value must be 5 digits or less2. Conditional3. Value is mandatory when associated Type of Service (CLT.003.211) equals "046"4. Value must be less than or equal to the number of days between (ending date of service minus beginning date of service) plus one day5. When populated, if value is greater than 0 and less than 99998, then Level of Care Status (ELG.005.088) for the associated MSIS Identification Number (CLT.002.022) must equal '004' (ICF/IID) for the same month as the begin and end date of service
09/12/2024	3.29.0	CLT.002.145	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CLT.002.141	UPDATE	Coding requirement	1. Value must be in Patient Status List (VVL).2. Value must be 2 characters3. Mandatory	1. Value must be in Patient Status List (VVL)2. Value must be 2 characters3. Mandatory
09/12/2024	3.29.0	CLT.002.140	UPDATE	Coding requirement	1. Conditional2. Value must be 12 characters or less3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value = "00", then value must not be populated.5. Value must be populated when Crossover Indicator (CLT.002.023) equals '1' and Medicare Beneficiary Identifier (CLT.002.168) is not populated.	1. Conditional2. Value must be 12 characters or less3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value = "00", then value must not be populated5. Value must be populated when Crossover Indicator (CLT.002.023) equals "1" and Medicare Beneficiary Identifier (CLT.002.168) is not populated
09/12/2024	3.29.0	CLT.002.136	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Value must exist in the NPPES NPI data file4. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional
09/12/2024	3.29.0	CLT.002.134	UPDATE	Coding requirement	1. Value must be in Provider Specialty List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Provider Specialty List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CLT.002.133	UPDATE	Coding requirement	1. Value must be in Provider Type Code List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Provider Type Code List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CLT.002.131	UPDATE	Coding requirement	1. Value must be 10 digits 2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2' 3. Value must exist in the NPPES NPI data file 4. Conditional 5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal '01' 6. When Type of Claim is in ['1','3','A','C'], then value must be populated 7. When Type of Claim not in ('3','C','W'), then value must match Provider Identifier (PRV.002.081) 8. NPPES Entity Type Code associated with this NPI must equal ‘2’ (Organization)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. When Type of Claim is in [1,3,A,C], then value must be populated7. When Type of Claim not in [3,C,W], then value must match Provider Identifier (PRV.002.081)8. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)
09/12/2024	3.29.0	CLT.002.130	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier where the Provider Identifier5. Ending Date of Service (CLT.002.049) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Ending Date of Service (CLT.002.049) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)7. Ending Date of Service (CLT.002.049) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Ending Date of Service (CLT.002.049) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [Z,3,C,W,2,B,V,4,D,X] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [Z,3,C,W,2,B,V,4,D,X] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.007) equal to "2"5. Ending Date of Service (CLT.002.049) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Ending Date of Service (CLT.002.049) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)7. Ending Date of Service (CLT.002.049) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Ending Date of Service (CLT.002.049) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)
09/12/2024	3.29.0	CLT.002.129	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by a version number [0-9] in the 12th position 5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be "01" or in [21-30](1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional
09/12/2024	3.29.0	CLT.002.127	UPDATE	Coding requirement	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Conditional	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Conditional
09/12/2024	3.29.0	CLT.002.122	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Conditional	1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional
02/27/2025	3.34.0	CLT.002.101	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CLT.002.100	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CLT.002.099	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CLT.002.098	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CLT.002.097	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CLT.002.096	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CLT.002.095	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CLT.002.094	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CLT.002.093	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CLT.002.092	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
09/12/2024	3.29.0	CLT.002.091	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Healthcare Acquired Condition Indicator List (VVL).4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Healthcare Acquired Condition Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	CLT.002.090	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Forced Claim Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Forced Claim Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	CLT.002.085	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CLT.002.083	UPDATE	Coding requirement	1. Value must be in Medicare Reimbursement Type List (VVL)2. Value is mandatory and must be provided, when Crossover Indicator is equal to '1' (Crossover Claim)3. Value must be 2 characters4. Conditional	1. Value must be in Medicare Reimbursement Type List (VVL)2. Value is mandatory and must be provided, when Crossover Indicator is equal to "1" (Crossover Claim)3. Value must be 2 characters4. Conditional
09/12/2024	3.29.0	CLT.002.082	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level.For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only.For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
09/12/2024	3.29.0	CLT.002.080	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional4. Value must match Managed Care Plan ID (ELG.014.192)5. Value must match State Plan ID Number (MCR.002.019)6. Value should not be populated when Type of Claim is not equal to '3', 'C' or 'W'7. When Type of Claim in (3, C, W, 2, B, V) value must have a managed care enrollment (ELG.014) for the beneficiary where the Beginning DOS (CLT.002.048) occurs between the managed care plan enrollment eff/end dates (ELG.014.197/198)8. When Type of Claim in (3, C, W, 2, B, V) value must have a managed care main record (MCR.002) for the plan where the Beginning DOS (CLT.002.048) occurs between the managed care contract eff/end dates (MCR.002.020/021)	1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional4. Value must match Managed Care Plan ID (ELG.014.192)5. Value must match State Plan ID Number (MCR.002.019)6. Value should not be populated when Type of Claim is in [3,C,W]7. When Type of Claim in [3,C,W,2,B,V] value must have a managed care enrollment (ELG.014) for the beneficiary where the Beginning DOS (CLT.002.048) occurs between the managed care plan enrollment eff/end dates (ELG.014.197/198)8. When Type of Claim in [3,C,W,2,B,V] value must have a managed care main record (MCR.002) for the plan where the Beginning DOS (CLT.002.048) occurs between the managed care contract eff/end dates (MCR.002.020/021)
09/12/2024	3.29.0	CLT.002.079	UPDATE	Coding requirement	1. Value must be in Program Type List (VVL)2. Value must be 2 characters3. Mandatory4. (Community First Choice) If value equals '11', then State Plan Option Type (ELG.011.163) must equal '01' for the same time period5. If value equals '13', then State Plan Option Type (ELG.011.163) must equal '02' for the same time period	1. Value must be in Program Type List (VVL)2. Value must be 2 characters3. Mandatory4. (Community First Choice) If value equals "11", then State Plan Option Type (ELG.011.163) must equal "01" for the same time period5. If value equals '13', then State Plan Option Type (ELG.011.163) must equal '02' for the same time period
09/12/2024	3.29.0	CLT.002.078	UPDATE	Coding requirement	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If value equals '1', then Total Medicare Coinsurance amount must not be populated.5. If value equals '0', then Crossover Indicator must equals '0'6. If value equals '1', then Crossover Indicator must equals '1'7. Conditional	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. If value equals "1", then Total Medicare Coinsurance amount must not be populated5. If value equals "0", then Crossover Indicator must equals "0"6. If value equals "1", then Crossover Indicator must equals "1"7. Conditional
09/12/2024	3.29.0	CLT.002.077	UPDATE	Coding requirement	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Value must be populated if TYPE-OF-CLAIM is not in [3,C,W,6]4. Conditional
09/12/2024	3.29.0	CLT.002.076	UPDATE	Coding requirement	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Value must be populated if TYPE-OF-CLAIM is not in [3,C,W,6]4. Conditional
09/12/2024	3.29.0	CLT.002.075	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Fixed Payment Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Fixed Payment Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	CLT.002.074	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim value is in [4, D, or X], then value is mandatory and must be provided4. Conditional5. When populated, Service Tracking Type must be populated6. When populated, Total Medicaid Amount must not be populated	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Type of Claim value is in [4,D,X], then value is mandatory and must be provided4. Conditional5. When populated, Service Tracking Type must be populated6. When populated, Total Medicaid Amount must not be populated
09/12/2024	3.29.0	CLT.002.073	UPDATE	Coding requirement	1. Value must be in Service Tracking Type List (VVL)2. (Service Tracking Claim) if associated Type of Claim is in ['4','D', 'X'] then value is mandatory and must be reported3. Value must be 2 characters4. Conditional	1. Value must be in Service Tracking Type List (VVL)2. (Service Tracking Claim) if associated Type of Claim is in [4,D,X] then value is mandatory and must be reported3. Value must be 2 characters4. Conditional
09/12/2024	3.29.0	CLT.002.071	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	CLT.002.070	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CLT.002.069	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional
09/12/2024	3.29.0	CLT.002.068	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is '0' (not a crossover claim), then value should not be populated.4. Conditional5. If associated Medicare Combined Deductible Indicator is '1', then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value is "0" (not a crossover claim), then value should not be populated4. Conditional5. If associated Medicare Combined Deductible Indicator is "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount
09/12/2024	3.29.0	CLT.002.067	UPDATE	Definition	The amount paid by Medicaid/CHIP, on this claim at the claim header level, toward the beneficiary's Medicare deductible. If the Medicare deductible amount can be identified separately from Medicare coinsurance payments, code that amount in this field. If the Medicare coinsurance and deductible payments cannot be separated, fill this field with the combined payment amount, code Medicare Combined Indicator a "1" and leave Total Medicare Coinsurance Amount unpopulated.	The amount paid by Medicaid/CHIP, on this claim at the claim header level, toward the beneficiary's Medicare deductible. If the Medicare deductible amount can be identified separately from Medicare coinsurance payments, code that amount in this field. If the Medicare coinsurance and deductible payments cannot be separated, fill this field with the combined payment amount, code Medicare Combined Indicator a '1' and leave Total Medicare Coinsurance Amount unpopulated.
09/12/2024	3.29.0	CLT.002.067	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is '0' (not a crossover claim), then value should not be populated.4. Conditional5. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value is "0" (not a crossover claim), then value should not be populated4. Conditional5. When populated, value must be less than or equal to Total Billed Amount
09/12/2024	3.29.0	CLT.002.065	UPDATE	Definition	The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CLT.002.065	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must not be greater than Total Allowed Amount8. Value must be populated, when Type of Claim is in [‘1’, ‘A’]9. Value must not be populated or equal to ‘0.00’ when associated Claim Status is in ['26', '026', '87', '087', '542', '585', '654']10. Value should not be populated, when associated Type of Claim value is in [‘4’, ‘D’] 11. Value must be less than Total Allowed Amount11. Value must be populated when the associated Type of Claim (CLT.002.052) is in [‘5’, ‘E’]	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must not be greater than Total Allowed Amount8. Value must be populated, when Type of Claim is in [1,A]9. Value must not be populated or equal to "0.00" when associated Claim Status is in [26,026,87,087,542,585,654]10. Value should not be populated, when associated Type of Claim value is in [4,D]11. Value must be less than Total Allowed Amount12. Value must be populated when the associated Type of Claim (CLT.002.052) is in [5,E]
09/12/2024	3.29.0	CLT.002.064	UPDATE	Definition	The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity allowed for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The claim header level maximum amount determined by the payer as being "allowable" under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state"s MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity allowed for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CLT.002.064	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. When populated and Payment Level Indicator = '2' then value must equal the sum of all claim line Allowed Amount values4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. When populated and Payment Level Indicator equals "2" then value must equal the sum of all claim line Allowed Amount values4. Conditional
09/12/2024	3.29.0	CLT.002.063	UPDATE	Definition	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CLT.002.063	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. When associated Type of Claim in [‘1’, ’3’, ’A’, ’C’], value must be populated 6. Value should not be populated when associated Type of Claim (CLT.002.052) is equal to '4', 'D' or 'X'7. (individual line item payments) when populated and Payment Level Indicator (CLT.002.082) equals = '2' value must be greater than or equal to the sum of all claim line Revenue Charges (CLT.003.204)	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. When associated Type of Claim in [1,3,A,C] and Source Location does not equal "23", value must be populated6. Value should not be populated when associated Type of Claim (CLT.002.052) is in [4,D,X]7. (individual line item payments) when populated and Payment Level Indicator (CLT.002.082) equals "2" value must be greater than or equal to the sum of all claim line Revenue Charges (CLT.003.204)
09/12/2024	3.29.0	CLT.002.056	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = "22" to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = "23" to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.
09/12/2024	3.29.0	CLT.002.055	UPDATE	Coding requirement	1. Value must be in Claim Status Category List (VVL)2. (Denied Claim) if associated Claim Denied Indicator indicates the claim was denied, then value must be "F2"3. (Denied Claim) if associated Claim Status is in [ 542, 585, 654 ], then value must be "F2"4. Value must be 3 characters or less5. Mandatory	1. Value must be in Claim Status Category List (VVL)2. (Denied Claim) if associated Claim Denied Indicator indicates the claim was denied, then value must be "F2"3. (Denied Claim) if associated Claim Status is in [542,585,654], then value must be "F2"4. Value must be 3 characters or less5. Mandatory
09/12/2024	3.29.0	CLT.002.054	UPDATE	Coding requirement	1. Value must be in Claim Status List (VVL)2. Value must be 3 characters or less3. Conditional4. If value in [ 542, 585, 654 ], Claim Denied Indicator must be '0' and Claim Status Category must be 'F2'	1. Value must be in Claim Status List (VVL)2. Value must be 3 characters or less3. Conditional4. If value in [542,585,654], Claim Denied Indicator must be "0" and Claim Status Category must be "F2"
09/12/2024	3.29.0	CLT.002.053	UPDATE	Coding requirement	1. Value must be in Type of Bill List (VVL)2. Value must be 4 characters3. First character must be a '0'4. Mandatory	1. Value must be in Type of Bill List (VVL)2. Value must be 4 characters3. First character must be a "0"4. Mandatory
09/12/2024	3.29.0	CLT.002.052	UPDATE	Definition	A code to indicate what type of payment is covered in this claim.For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.
09/12/2024	3.29.0	CLT.002.052	UPDATE	Coding requirement	1. Value must be in Type of Claim List (VVL)2. Value must be 1 character3. Mandatory4. When value equals 'Z', claim denied indicator must equal '0'	1. Value must be in Type of Claim List (VVL)2. Value must be 1 character3. Mandatory4. When value equals 'Z', claim denied indicator must equal "0"
09/12/2024	3.29.0	CLT.002.049	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated End of Time Period value4. Value must be greater than or equal to associated Beginning Date of Service value5. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be equal to or greater than associated Date of Birth (ELG.002.024) value8. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated End of Time Period value4. Value must be greater than or equal to associated Beginning Date of Service value5. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be equal to or greater than associated Date of Birth (ELG.002.024) value8. Mandatory
09/12/2024	3.29.0	CLT.002.048	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated End of Time Period value4. Value must be less than or equal to associated Ending Date of Service value5. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be less than or equal to at least one of the eligible's Enrollment End Date (ELG.021.254) values8. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated End of Time Period value4. Value must be less than or equal to associated Ending Date of Service value5. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be less than or equal to at least one of the eligible's Enrollment End Date (ELG.021.254) values8. Mandatory
09/12/2024	3.29.0	CLT.002.046	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be less than or equal to associated Adjudication Date value.4. Value must be greater than or equal to associated Admission Date value.5. Value must be greater than or equal to associated eligible Date of Birth value.6. Value must be less than or equal to associated eligible Date of Death value.7. Conditional8. When populated, Discharge Hour (CLT.002.047) must be populated	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be less than or equal to associated Adjudication Date value4. Value must be greater than or equal to associated Admission Date value5. Value must be greater than or equal to associated eligible Date of Birth value6. Value must be less than or equal to associated eligible Date of Death value7. Conditional8. When populated, Discharge Hour (CLT.002.047) must be populated
09/12/2024	3.29.0	CLT.002.044	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be less than or equal to associated Discharge Date value in the claim header.4. Value must be greater than or equal to associated eligible Date of Birth value.5. Value must be less than or equal to associated eligible Date of Death value.6. Mandatory7. When associated Type of Claim (CLT.002.052) is not '2','B' or 'V' (capitated payment) value must be before Adjudication Date (CLT.002.050)8. When associated Type of Claim (CLT.002.052) is not '2','B' or 'V' (capitated payment) and Type of Service (CLT.003.211) is not '119, '120', '121', 122' value must be before Adjudication Date (CLT.003.233)	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be less than or equal to associated Discharge Date value in the claim header4. Value must be greater than or equal to associated eligible Date of Birth value5. Value must be less than or equal to associated eligible Date of Death value6. Mandatory7. When associated Type of Claim (CLT.002.052) is not in [2,B,V] (capitated payment) value must be before Adjudication Date (CLT.002.050)8. When associated Type of Claim (CLT.002.052) is not [2,B,V] (capitated payment) and Type of Service (CLT.003.211) is not [119,120,121,122] value must be before Adjudication Date (CLT.003.233)
09/12/2024	3.29.0	CLT.002.024	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Conditional5. When value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Conditional5. When value equals "0", is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated
09/12/2024	3.29.0	CLT.002.023	UPDATE	Coding requirement	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service)5. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported.6. Conditional	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in [01,02,04,08,09,10] for the same time period (by date of service)5. If the Type of Claim value is in [1,3,A,C], then value is mandatory and must be reported6. Conditional
09/12/2024	3.29.0	CLT.002.022	UPDATE	Coding requirement	1. Mandatory2. Value must be 20 characters or less3. Populated value must begin with an '&', when TYPE-OF-CLAIM = 4, D or X (lump sum payment)4. The Beginning Date of Service on the claim must fall between (ELG.021.253) enrollment effective and (ELG.021.253) end date	1. Mandatory2. Value must be 20 characters or less3. When TYPE-OF-CLAIM is in [4,D,X] (lump sum payment), value must begin with an "&"4. The Beginning Date of Service on the claim must fall between (ELG.021.253) enrollment effective and (ELG.021.253) end date
09/12/2024	3.29.0	CLT.002.020	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [‘4’, ‘1’] then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated
09/12/2024	3.29.0	CLT.001.011	UPDATE	Coding requirement	1. For production files, value must be equal to 'P'2. Value must be in File Status Indicator List (VVL)3. Value must be 1 character4. Mandatory	1. For production files, value must be equal to "P"2. Value must be in File Status Indicator List (VVL)3. Value must be 1 character4. Mandatory
09/12/2024	3.29.0	CLT.001.006	UPDATE	Coding requirement	1. Value must equal 'CLAIM-LT'2. Mandatory	1. Value must equal "CLAIM-LT"2. Mandatory
09/12/2024	3.29.0	CIP.003.296	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1]3. Mandatory	1. Value must be 1 character2. Value must be in [0,1]3. Mandatory
09/12/2024	3.29.0	CIP.003.285	UPDATE	Coding requirement	1. Value must be in NDC Unit of Measure List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in NDC Unit of Measure List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CIP.003.272	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CIP.003.271	UPDATE	Coding requirement	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '02', then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is "02", then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less
09/12/2024	3.29.0	CIP.003.270	UPDATE	Coding requirement	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is '01', then a valid value is mandatory and must be reported5. If value is in ['14', '35', '42' or '44'], then Sex (ELG.002.023) must not equals 'M'6. If XXI MBESCBES Category of Service is populated then must not be populated	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is "01", then a valid value is mandatory and must be reported5. If value is in [14,35,42,44], then Sex (ELG.002.023) must not equal "M"6. If XXI MBESCBES Category of Service is populated then must not be populated
09/12/2024	3.29.0	CIP.003.269	UPDATE	Coding requirement	1. Value must be in CMS 64 Category for Federal Reimbursement List (VVL)2. Value must be 2 characters3. (Federal Funding under Title XXI) if value equals '02', then the eligible's CHIP Code (ELG.003.054) must be in ['2', '3']4. (Federal Funding under Title XIX) if value equals '01' then the eligible's CHIP Code (ELG.003.054) must be '1'5. Conditional6. If Type of Claim is in ['1','2','5','A','B','E','U','V','Y'] and the Total Medicaid Paid Amount is populated on the corresponding claim header, then value must be reported7. If Type of Claim is in ['4','D'] and the Service Tracking Payment Amount on the relevant record is populated, then value must be reported8. When Type of Claim is in [‘1’,‘A’], value must be populated	1. Value must be in CMS 64 Category for Federal Reimbursement List (VVL)2. Value must be 2 characters3. (Federal Funding under Title XXI) if value equals "02", then the eligible's CHIP Code (ELG.003.054) must be in [2,3]4. (Federal Funding under Title XIX) if value equals "01" then the eligible's CHIP Code (ELG.003.054) must be "1"5. Conditional6. If Type of Claim is in [1,2,5,A,B,E,U,V,Y] and the Total Medicaid Paid Amount is populated on the corresponding claim header, then value must be reported7. If Type of Claim is in [4,D] and the Service Tracking Payment Amount on the relevant record is populated, then value must be reported8. When Type of Claim is in [1,A], value must be populated
09/12/2024	3.29.0	CIP.003.264	UPDATE	Coding requirement	1. Value must be in Provider Specialty List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Provider Specialty List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CIP.003.263	UPDATE	Coding requirement	1. Value must be in Provider Type Code List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Provider Type Code List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CIP.003.257	UPDATE	Coding requirement	1. Value must be 3 characters2. Mandatory3. Value must not equal '086' if Sex (ELG.002.023) equals 'M'4. Value must be in ['001', '058', '060', '084', '086', '090', '091', '092', '093', '123', '132', '135', '136', '137']	1. Value must be 3 characters2. Mandatory3. Value must not equal "086" if Sex (ELG.002.023) equals "M"4. Value must be in [001,058,060,084,086,090,091,092,093,123,132,135,136,137]
09/12/2024	3.29.0	CIP.003.256	UPDATE	Coding requirement	1. Value must be in Billing Unit List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Billing Unit List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CIP.003.255	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim value equals '3, C, W', then value is mandatory and must be provided4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Type of Claim value is in [3,C,W], then value is mandatory and must be provided4. Conditional
09/12/2024	3.29.0	CIP.003.254	UPDATE	Definition	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CIP.003.254	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional4. Value should not be populated or equal to zero, when associated Claim Line Status is in ['26', '026', '87', '087', '542', '585', '654']	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional4. Value should not be populated or equal to zero, when associated Claim Line Status is in [26,026,87,087,542,585,654]
09/12/2024	3.29.0	CIP.003.252	UPDATE	Definition	The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity allowed at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The maximum amount displayed at the claim line level as determined by the payer as being "allowable" under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state"s MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity allowed at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CIP.003.252	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CIP.003.251	UPDATE	Definition	The total amount billed for the related Revenue Code. Total amount billed includes both covered and non-covered charges (as defined by UB-04 Billing Manual). For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed to the managed care plan.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The total amount billed for the related Revenue Code. Total amount billed includes both covered and non-covered charges (as defined by UB-04 Billing Manual). For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed to the managed care plan. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CIP.003.251	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than or equal to associated Total Billed Amount value4. When populated, associated claim line Revenue Charge must be populated5. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than or equal to associated Total Billed Amount value4. When populated and the Source Location does not equal “23”, the associated claim line Revenue Code must be populated5. Conditional
09/12/2024	3.29.0	CIP.003.245	UPDATE	Coding requirement	1. Value must be in Revenue Code List (VVL)2. A Revenue Code value requires an associated Revenue Charge3. Value must be 4 characters or less4. Mandatory	1. Value must be in Revenue Code List (VVL)2. When Source Location does not equal “23”, value requires an associated Revenue Charge3. Value must be 4 characters or less4. Mandatory
09/12/2024	3.29.0	CIP.003.244	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated End of Time Period value4. Value must be greater than or equal to associated Beginning Date of Service value5. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be equal to or greater than associated Date of Birth (ELG.002.024) value8. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated End of Time Period value4. Value must be greater than or equal to associated Beginning Date of Service value5. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be equal to or greater than associated Date of Birth (ELG.002.024) value8. Mandatory
09/12/2024	3.29.0	CIP.003.243	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated End of Time Period value4. Value must be less than or equal to associated Ending Date of Service value5. When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be less than or equal to at least one of the eligible's Enrollment End Date (ELG.021.254) values8. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated End of Time Period value4. Value must be less than or equal to associated Ending Date of Service value5. When Type of Claim is not in [2,4,B,D,V] value must be less than or equal to associated Adjudication Date value6. Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated7. Value must be less than or equal to at least one of the eligible's Enrollment End Date (ELG.021.254) values8. Mandatory
09/12/2024	3.29.0	CIP.003.242	UPDATE	Coding requirement	1. Value must be in Claim Status List (VVL)2. Value must be 3 characters or less3. Conditional4. If value in [545, 585, 654], then Claim Denied Indicator must be '0' and Claim Status Category must be 'F2'	1. Value must be in Claim Status List (VVL)2. Value must be 3 characters or less3. Conditional4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2"
09/12/2024	3.29.0	CIP.003.239	UPDATE	Coding requirement	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [1,3,5,A,C,E,U,W,Y], then value must be in [0,1,4]3. If associated Type of Claim value is in [4,D,X], then value must be in [5,6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated
09/12/2024	3.29.0	CIP.003.236	UPDATE	Coding requirement	Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [‘4’, ‘1’] then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1] then value must be populated
09/12/2024	3.29.0	CIP.003.234	UPDATE	Coding requirement	1. Mandatory2. Value must be 20 characters or less3. When Type of Claim (CIP.002.100) = 4, D or X (lump sum payment) value must begin with an '&'	1. Mandatory2. Value must be 20 characters or less3. When Type of Claim (CIP.002.100) is in [4,D,X] (lump sum payment) value must begin with an "&"
09/12/2024	3.29.0	CIP.002.295	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CIP.002.294	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CIP.002.293	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CIP.002.292	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CIP.002.228	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is "0", then the value must not be populated.4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value is "0", then the value must not be populated4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"
09/12/2024	3.29.0	CIP.002.222	UPDATE	Coding requirement	1. Conditional2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S, L, O, I, B, Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S, L, O, I, B, Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)11. Character 9 must be alphabetic values A thru Z (minus S, L, O, I, B, Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols	1. Conditional2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols
09/12/2024	3.29.0	CIP.002.221	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2' 3. Value must exist in the NPPES NPI data file4. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional
09/12/2024	3.29.0	CIP.002.220	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional4. When Type of Claim is in ['4', 'D', 'X'], value must not be populated	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional4. When Type of Claim is in [4,D,X], value must not be populated
09/12/2024	3.29.0	CIP.002.218	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Situational	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
09/12/2024	3.29.0	CIP.002.216	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Situational	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational
09/12/2024	3.29.0	CIP.002.214	UPDATE	Definition	A free-form text field to indicate the health home program that authorized payment for the service on the claim or to identify the health home SPA in which an individual is enrolled. The name entered should be the name that the state uses to uniquely identify the team. A "Health Home Entity" can be a designated provider (e.g., physician, clinic, behavioral health organization), a health team which links to a designated provider, or a health team (physicians, nurses, behavioral health professionals). Because an identification numbering schema has not been established, the entities' names are being used instead.	A free-form text field to indicate the health home program that authorized payment for the service on the claim or to identify the health home SPA in which an individual is enrolled. The name entered should be the name that the state uses to uniquely identify the team. A "Health Home Entity" can be a designated provider (e.g., physician, clinic, behavioral health organization), a health team which links to a designated provider, or a health team (physicians, nurses, behavioral health professionals). Because an identification numbering schema has not been established, the entities" names are being used instead.
09/12/2024	3.29.0	CIP.002.213	UPDATE	Coding requirement	1. Value must be in Copay Waived Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. Situational	1. Value must be in Copay Waived Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. Situational
09/12/2024	3.29.0	CIP.002.212	UPDATE	Coding requirement	1. Value must be in Claim Denied Indicator List (VVL)2. If value is '0', then Claim Status Category must equal "F2"3. Value must be 1 character4. Mandatory	1. Value must be in Claim Denied Indicator List (VVL)2. If value is "0", then Claim Status Category must equal "F2"3. Value must be 1 character4. Mandatory
09/12/2024	3.29.0	CIP.002.210	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CIP.002.208	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CIP.002.206	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CIP.002.204	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Border State Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Border State Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	CIP.002.199	UPDATE	Coding requirement	1. Value must be in Patient Status List (VVL).2. Value must be 2 characters3. Mandatory4. When value in ["20", "40", "41", "42"], then associated Discharge Date (CIP.002.096) must be less than or equal to Date of Death (ELG.002.025)	1. Value must be in Patient Status List (VVL)2. Value must be 2 characters3. Mandatory4. When value in [20,40,41,42], then associated Discharge Date (CIP.002.096) must be less than or equal to Date of Death (ELG.002.025)
09/12/2024	3.29.0	CIP.002.198	UPDATE	Coding requirement	1. Value must be numeric2. The value may be up to 5 digits in length3. Value must be populated, if Outlier Code (CIP.002.197) equals '01.'4. Conditional	1. Value must be numeric2. The value may be up to 5 digits in length3. Value must be populated, if Outlier Code (CIP.002.197) equals "01"4. Conditional
09/12/2024	3.29.0	CIP.002.196	UPDATE	Coding requirement	1. Conditional2. Value must be 12 characters or less3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value = "00", then value must not be populated.5. Value must be populated when Crossover Indicator (CIP.002.023) equals '1' and Medicare Beneficiary Identifier (CIP.002.222) is not populated.	1. Conditional2. Value must be 12 characters or less3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value equals "00", then value must not be populated5. Value must be populated when Crossover Indicator (CIP.002.023) equals "1" and Medicare Beneficiary Identifier (CIP.002.222) is not populated
09/12/2024	3.29.0	CIP.002.194	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be populated when Outlier Code (CIP.002.197) is in [01,02,10]4. Conditional
09/12/2024	3.29.0	CIP.002.190	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Value must exist in the NPPES NPI data file4. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional
09/12/2024	3.29.0	CIP.002.188	UPDATE	Coding requirement	1. Value must be in Provider Type Code List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Provider Type Code List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CIP.002.186	UPDATE	Coding requirement	1. Value must be in Provider Specialty List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Provider Specialty List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CIP.002.184	UPDATE	Coding requirement	1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to '2'4. Value must exist in the NPPES NPI File	1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File
09/12/2024	3.29.0	CIP.002.183	UPDATE	Coding requirement	1. Value must be in Provider Specialty List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Provider Specialty List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CIP.002.182	UPDATE	Coding requirement	1. Value must be in Provider Type Code List (VVL).2. Value must be 2 characters3. Conditional	1. Value must be in Provider Type Code List (VVL)2. Value must be 2 characters3. Conditional
09/12/2024	3.29.0	CIP.002.180	UPDATE	Coding requirement	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal '01'6. When Type of Claim is in ['1','3','A','C'], then value must be populated7. NPPES Entity Type Code associated with this NPI must equal ‘2’ (Organization)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. When Type of Claim is in [1,3,A,C], then value must be populated7. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)
09/12/2024	3.29.0	CIP.002.179	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier where the Provider Identifier5. Discharge Date (CIP.002.096) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CIP.002.096) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)7. Discharge Date (CIP.002.096) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Discharge Date (CIP.002.096) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [Z,3,C,W,2,B,V,4,D,X) then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in (Z,3,C,W,2,B,V,4,D,X) then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.081) equal to "1"5. Discharge Date (CIP.002.096) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CIP.002.096) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)7. Discharge Date (CIP.002.096) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Discharge Date (CIP.002.096) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)
09/12/2024	3.29.0	CIP.002.178	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by a version number [0-9] in the 12th position 5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30](1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional
09/12/2024	3.29.0	CIP.002.176	UPDATE	Coding requirement	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Conditional	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Conditional
09/12/2024	3.29.0	CIP.002.167	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
02/27/2025	3.34.0	CIP.002.149	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CIP.002.148	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CIP.002.147	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CIP.002.146	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CIP.002.145	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CIP.002.144	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CIP.002.143	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CIP.002.142	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CIP.002.141	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
02/27/2025	3.34.0	CIP.002.140	UPDATE	Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
09/12/2024	3.29.0	CIP.002.139	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Healthcare Acquired Condition Indicator List (VVL).4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Healthcare Acquired Condition Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	CIP.002.138	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Forced Claim Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Forced Claim Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	CIP.002.136	UPDATE	Coding requirement	1. Value must be a positive integer2. Value must be between 0:99999999999 (inclusive)3. Conditional4. Value must be less than or equal to double the number of days between Admission Date Discharge Date (CIP.002.094) and Discharge Date Discharge Date (CIP.002.096) plus one day5. Value must be 7 digits or less6. Value is required if the associated Type of Service (CIP.002.257) is in [001, 058, 060, 084, 086, 090, 091, 092, 093, 123, 132]7. Value is required if at least one associated Revenue Code (CIP.003.245) is in [100-219]	1. Value must be a positive integer2. Value must be between 0:99999999999 (inclusive)3. Conditional4. Value must be less than or equal to double the number of days between Admission Date Discharge Date (CIP.002.094) and Discharge Date Discharge Date (CIP.002.096) plus one day5. Value must be 7 digits or less6. Value is required if the associated Type of Service (CIP.002.257) is in [001,058,060,084,086,090,091,092,093,123,132]7. Value is required if at least one associated Revenue Code (CIP.003.245) is in [100-219]
09/12/2024	3.29.0	CIP.002.135	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CIP.002.133	UPDATE	Coding requirement	1. Value must be in Medicare Reimbursement Type List (VVL)2. Value is mandatory and must be provided, when Crossover Indicator is equal to '1' (Crossover Claim)3. Value must be 2 characters4. Conditional	1. Value must be in Medicare Reimbursement Type List (VVL)2. Value is mandatory and must be provided, when Crossover Indicator is equal to "1" (Crossover Claim)3. Value must be 2 characters4. Conditional
09/12/2024	3.29.0	CIP.002.132	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level.For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only.For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.	The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
09/12/2024	3.29.0	CIP.002.130	UPDATE	Coding requirement	1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional4. Value must match Managed Care Plan ID (ELG.014.192)5. Value must match State Plan ID Number (MCR.002.019)6. When Type of Claim (CIP.002.100) in (3, C, W, 2, B, V) value must have a managed care enrollment (ELG.014) for the beneficiary where the Admission Date (CIP.002.094) occurs between the managed care plan enrollment eff/end dates (ELG.014.197/198)7. When Type of Claim (CIP.002.100) in (3, C, W, 2, B, V) value must have a managed care main record (MCR.002) for the plan where the Admission Date (CIP.002.094) occurs between the managed care contract eff/end dates (MCR.002.020/021)	1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional4. Value must match Managed Care Plan ID (ELG.014.192)5. Value must match State Plan ID Number (MCR.002.019)6. When Type of Claim (CIP.002.100) in (3,C,W,2,B,V) value must have a managed care enrollment (ELG.014) for the beneficiary where the Admission Date (CIP.002.094) occurs between the managed care plan enrollment eff/end dates (ELG.014.197/198)7. When Type of Claim (CIP.002.100) in (3,C,W,2,B,V) value must have a managed care main record (MCR.002) for the plan where the Admission Date (CIP.002.094) occurs between the managed care contract eff/end dates (MCR.002.020/021)
09/12/2024	3.29.0	CIP.002.129	UPDATE	Coding requirement	1. Value must be in Program Type List (VVL)2. Value must be 2 characters3. Mandatory4. (Community First Choice) If value equals '11', then State Plan Option Type (ELG.011.163) must equal '01' for the same time period5. If value equals '13', then State Plan Option Type (ELG.011.163) must equal '02' for the same time period	1. Value must be in Program Type List (VVL)2. Value must be 2 characters3. Mandatory4. (Community First Choice) If value equals "11", then State Plan Option Type (ELG.011.163) must equal "01" for the same time period5. If value equals "13", then State Plan Option Type (ELG.011.163) must equal "02" for the same time period
09/12/2024	3.29.0	CIP.002.128	UPDATE	Coding requirement	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If value equals '1', then Total Medicare Coinsurance amount must not be populated.5. If value equals '0', then Crossover Indicator must equals '0'6. If value equals '1', then Crossover Indicator must equals '1'7. Conditional	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. If value equals "1", then Total Medicare Coinsurance amount must not be populated5. If value equals "0", then Crossover Indicator must equals "0"6. If value equals "1", then Crossover Indicator must equals "1"7. Conditional
09/12/2024	3.29.0	CIP.002.127	UPDATE	Coding requirement	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Value must be populated if Type of Claim is not equal to [3,C,W,6]4. Conditional
09/12/2024	3.29.0	CIP.002.126	UPDATE	Coding requirement	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Value must be populated if Type of Claim is not equal to [3,C,W,6]4. Conditional
09/12/2024	3.29.0	CIP.002.125	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Fixed Payment Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Fixed Payment Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	CIP.002.124	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim value is in [4, D, or X], then value is mandatory and must be provided4. Conditional5. When populated, Service Tracking Type must be populated6. When populated, Total Medicaid Amount must not be populated	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Type of Claim value is in [4,D,X], then value is mandatory and must be provided4. Conditional5. When populated, Service Tracking Type must be populated6. When populated, Total Medicaid Amount must not be populated
09/12/2024	3.29.0	CIP.002.123	UPDATE	Coding requirement	1. Value must be in Service Tracking Type List (VVL)2. (Service Tracking Claim) if associated Type of Claim is in ['4','D', 'X'] then value is mandatory and must be reported3. Value must be 2 characters4. Conditional	1. Value must be in Service Tracking Type List (VVL)2. (Service Tracking Claim) if associated Type of Claim is in [4,D,X] then value is mandatory and must be reported3. Value must be 2 characters4. Conditional
09/12/2024	3.29.0	CIP.002.121	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Conditional
09/12/2024	3.29.0	CIP.002.119	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
09/12/2024	3.29.0	CIP.002.118	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional
09/12/2024	3.29.0	CIP.002.117	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is '0' (not a crossover claim), then value should not be populated.4. Conditional5. If associated Medicare Combined Deductible Indicator is '1', then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value is "0" (not a crossover claim), then value should not be populated4. Conditional5. If associated Medicare Combined Deductible Indicator is "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount
09/12/2024	3.29.0	CIP.002.116	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is '0' (not a crossover claim), then value should not be populated.4. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in ["01", "02", "03", "04", "05", "06", "08", "09", or "10"], then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value is "0" (not a crossover claim), then value should not be populated4. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10], then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount
09/12/2024	3.29.0	CIP.002.114	UPDATE	Definition	The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CIP.002.114	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must be populated, when Type of Claim is in [‘1’, ‘A’]8. Value must not be populated or equal to ‘0.00’ when associated Claim Status is in ['26', '026', '87', '087', '542', '585', '654']9. Value should not be populated, when associated Type of Claim value is in [‘4’, ‘D’] 10. Value must be populated when the associated Type of Claim (CIP.002.100) is in [‘5’, ‘E’]11. Value must not be greater than Total Allowed Amount (CIP.002.113)	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must be populated, when Type of Claim is in [1,A]8. Value must not be populated or equal to "0.00" when associated Claim Status is in [26,026,87,087,542,585,654]9. Value should not be populated, when associated Type of Claim value is in [4,D]10. Value must be populated when the associated Type of Claim (CIP.002.100) is in [5,E]11. Value must not be greater than Total Allowed Amount (CIP.002.113)
09/12/2024	3.29.0	CIP.002.113	UPDATE	Definition	The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity allowed for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The claim header level maximum amount determined by the payer as being "allowable" under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state"s MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity allowed for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CIP.002.113	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. When populated and Payment Level Indicator = '2' then value must equal the sum of all claim line Allowed Amount values4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. When populated and Payment Level Indicator equals "2" then value must equal the sum of all claim line Allowed Amount values4. Conditional
09/12/2024	3.29.0	CIP.002.112	UPDATE	Definition	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CIP.002.112	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. When associated Type of Claim in [‘1’, ’3’, ’A’, ’C’], value must be populated6. (individual line item payments) when populated and Payment Level Indicator (CIP.002.132) equals = '2' value must be greater than or equal to the sum of all claim line Revenue Charges (CIP.003.251)	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. When associated Type of Claim in [1,3,A,C] and Source Location does not equal "23", value must be populated6. (individual line item payments) when populated and Payment Level Indicator (CIP.002.132) equals "2" value must be greater than or equal to the sum of all claim line Revenue Charges (CIP.003.251)
09/12/2024	3.29.0	CIP.002.104	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = "22" to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = "23" to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.
09/12/2024	3.29.0	CIP.002.103	UPDATE	Coding requirement	1. Value must be in Claim Status Category List (VVL)2. (Denied Claim) if associated Claim Denied Indicator indicates the claim was denied, then value must be "F2"3. (Denied Claim) if associated Claim Status is in [ 542, 585, 654 ], then value must be "F2"4. Value must be 3 characters or less5. Mandatory	1. Value must be in Claim Status Category List (VVL)2. (Denied Claim) if associated Claim Denied Indicator indicates the claim was denied, then value must be "F2"3. (Denied Claim) if associated Claim Status is in [542,585,654 ], then value must be "F2"4. Value must be 3 characters or less5. Mandatory
09/12/2024	3.29.0	CIP.002.102	UPDATE	Coding requirement	1. Value must be in Claim Status List (VVL)2. Value must be 3 characters or less3. Conditional4. If value in [ 542, 585, 654 ], Claim Denied Indicator must be '0' and Claim Status Category must be 'F2'	1. Value must be in Claim Status List (VVL)2. Value must be 3 characters or less3. Conditional4. If value in [542,585,654], Claim Denied Indicator must be "0" and Claim Status Category must be "F2"
09/12/2024	3.29.0	CIP.002.101	UPDATE	Coding requirement	1. Value must be in Type of Bill List (VVL)2. Value must be 4 characters3. First character must be a '0'4. Mandatory	1. Value must be in Type of Bill List (VVL)2. Value must be 4 characters3. First character must be a "0"4. Mandatory
09/12/2024	3.29.0	CIP.002.100	UPDATE	Definition	A code to indicate what type of payment is covered in this claim.For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.
09/12/2024	3.29.0	CIP.002.100	UPDATE	Coding requirement	1. Value must be in Type of Claim List (VVL)2. Value must be 1 character3. Mandatory4. When value equals 'Z', claim denied indicator must equal '0'	1. Value must be in Type of Claim List (VVL)2. Value must be 1 character3. Mandatory4. When value equals "Z", claim denied indicator must equal "0"
09/12/2024	3.29.0	CIP.002.096	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be less than or equal to associated Adjudication Date value.4. Value must be greater than or equal to associated Admission Date value.5. Value must be greater than or equal to associated eligible Date of Birth value.6. Value must be less than or equal to associated eligible Date of Death value.7. Conditional8. If associated Adjustment Indicator (CIP.002.026) does not equal "1" (Non-denied claims) and Patient Status (CIP.002.199) is not equal to "30" value must be populated.9. When populated, Discharge Hour (CIP.002.097) must be populated	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be less than or equal to associated Adjudication Date value4. Value must be greater than or equal to associated Admission Date value5. Value must be greater than or equal to associated eligible Date of Birth value6. Value must be less than or equal to associated eligible Date of Death value7. Conditional8. If associated Adjustment Indicator (CIP.002.026) does not equal "1" (Non-denied claims) and Patient Status (CIP.002.199) is not equal to "30" value must be populated9. When populated, Discharge Hour (CIP.002.097) must be populated
09/12/2024	3.29.0	CIP.002.094	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be less than or equal to associated Discharge Date value in the claim header.4. Value must be greater than or equal to associated eligible Date of Birth value.5. Value must be less than or equal to associated eligible Date of Death value.6. Mandatory7. Value must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)8. (capitated payment) when associated Type of Claim (CIP.002.100) is not '2','B' or 'V' and Type of Service (CIP.002.257) is not '119, '120', '121', 122' value must be before Adjudication Date (CIP.003.286)	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be less than or equal to associated Discharge Date value in the claim header.4. Value must be greater than or equal to associated eligible Date of Birth value5. Value must be less than or equal to associated eligible Date of Death value6. Mandatory7. Value must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)8. (capitated payment) when associated Type of Claim (CIP.002.100) is not in [2,B,V] and Type of Service (CIP.002.257) is not in [119,120,121,122] value must be before Adjudication Date (CIP.003.286)
09/12/2024	3.29.0	CIP.002.090	UPDATE	Coding requirement	1. When populated, there must be a corresponding Procedure Code Flag2. If associated Procedure Code Flag List (VVL) value indicates an ICD-9-CM encoding '02', then value must be a valid ICD-9-CM procedure code3. If associated Procedure Code Flag List (VVL) value indicates an ICD-10-CM encoding '07', then value must be a valid ICD-10-CM procedure code4. If associated Procedure Code Flag List (VVL) value indicates an "Other" encoding '10-87', then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code5. Value must be 8 characters or less6. Value must be in Procedure Code List (VVL)7. Conditional	1. When populated, there must be a corresponding Procedure Code Flag2. If associated Procedure Code Flag List (VVL) value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code3. If associated Procedure Code Flag List (VVL) value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code4. If associated Procedure Code Flag List (VVL) value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code5. Value must be 8 characters or less6. Value must be in Procedure Code List (VVL)7. Conditional
09/12/2024	3.29.0	CIP.002.086	UPDATE	Coding requirement	1. When populated, there must be a corresponding Procedure Code Flag2. If associated Procedure Code Flag List (VVL) value indicates an ICD-9-CM encoding '02', then value must be a valid ICD-9-CM procedure code3. If associated Procedure Code Flag List (VVL) value indicates an ICD-10-CM encoding '07', then value must be a valid ICD-10-CM procedure code4. If associated Procedure Code Flag List (VVL) value indicates an "Other" encoding '10-87', then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code5. Value must be 8 characters or less6. Value must be in Procedure Code List (VVL)7. Conditional	1. When populated, there must be a corresponding Procedure Code Flag2. If associated Procedure Code Flag List (VVL) value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code3. If associated Procedure Code Flag List (VVL) value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code4. If associated Procedure Code Flag List (VVL) value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code5. Value must be 8 characters or less6. Value must be in Procedure Code List (VVL)7. Conditional
09/12/2024	3.29.0	CIP.002.082	UPDATE	Coding requirement	1. When populated, there must be a corresponding Procedure Code Flag2. If associated Procedure Code Flag List (VVL) value indicates an ICD-9-CM encoding '02', then value must be a valid ICD-9-CM procedure code3. If associated Procedure Code Flag List (VVL) value indicates an ICD-10-CM encoding '07', then value must be a valid ICD-10-CM procedure code4. If associated Procedure Code Flag List (VVL) value indicates an "Other" encoding '10-87', then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code5. Value must be 8 characters or less6. Value must be in Procedure Code List (VVL)7. Conditional	1. When populated, there must be a corresponding Procedure Code Flag2. If associated Procedure Code Flag List (VVL) value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code3. If associated Procedure Code Flag List (VVL) value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code4. If associated Procedure Code Flag List (VVL) value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code5. Value must be 8 characters or less6. Value must be in Procedure Code List (VVL)7. Conditional
09/12/2024	3.29.0	CIP.002.078	UPDATE	Coding requirement	1. When populated, there must be a corresponding Procedure Code Flag2. If associated Procedure Code Flag List (VVL) value indicates an ICD-9-CM encoding '02', then value must be a valid ICD-9-CM procedure code3. If associated Procedure Code Flag List (VVL) value indicates an ICD-10-CM encoding '07', then value must be a valid ICD-10-CM procedure code4. If associated Procedure Code Flag List (VVL) value indicates an "Other" encoding '10-87', then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code5. Value must be 8 characters or less6. Value must be in Procedure Code List (VVL)7. Conditional	1. When populated, there must be a corresponding Procedure Code Flag2. If associated Procedure Code Flag List (VVL) value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code3. If associated Procedure Code Flag List (VVL) value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code4. If associated Procedure Code Flag List (VVL) value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code5. Value must be 8 characters or less6. Value must be in Procedure Code List (VVL)7. Conditional
09/12/2024	3.29.0	CIP.002.074	UPDATE	Coding requirement	1. When populated, there must be a corresponding Procedure Code Flag2. If associated Procedure Code Flag List (VVL) value indicates an ICD-9-CM encoding '02', then value must be a valid ICD-9-CM procedure code3. If associated Procedure Code Flag List (VVL) value indicates an ICD-10-CM encoding '07', then value must be a valid ICD-10-CM procedure code4. If associated Procedure Code Flag List (VVL) value indicates an "Other" encoding '10-87', then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code5. Value must be 8 characters or less6. Value must be in Procedure Code List (VVL)7. Conditional	1. When populated, there must be a corresponding Procedure Code Flag2. If associated Procedure Code Flag List (VVL) value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code3. If associated Procedure Code Flag List (VVL) value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code4. If associated Procedure Code Flag List (VVL) value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code5. Value must be 8 characters or less6. Value must be in Procedure Code List (VVL)7. Conditional
09/12/2024	3.29.0	CIP.002.072	UPDATE	Coding requirement	1. When populated, there must be a corresponding Procedure Code2. Value must be in Procedure Code Flag List (VVL)3. Value must be 2 characters4. Conditional5. If Procedure Code 1 (CIP.002.070) is populated, Procedure Code Flag 1 (CIP.002.072) must be '02' (ICD-9 CM) or '07' (ICD-10 - CM PCS).	1. When populated, there must be a corresponding Procedure Code2. Value must be in Procedure Code Flag List (VVL)3. Value must be 2 characters4. Conditional5. If Procedure Code 1 (CIP.002.070) is populated, Procedure Code Flag 1 (CIP.002.072) must be "02" (ICD-9 CM) or "07" (ICD-10-CM PCS).
09/12/2024	3.29.0	CIP.002.070	UPDATE	Coding requirement	1. When populated, there must be a corresponding Procedure Code Flag2. If associated Procedure Code Flag List (VVL) value indicates an ICD-9-CM encoding '02', then value must be a valid ICD-9-CM procedure code3. If associated Procedure Code Flag List (VVL) value indicates an ICD-10-CM encoding '07', then value must be a valid ICD-10-CM procedure code4. If associated Procedure Code Flag List (VVL) value indicates an "Other" encoding '10-87', then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code5. Value must be 8 characters or less6. Value must be in Procedure Code List (VVL)7. Conditional	1. When populated, there must be a corresponding Procedure Code Flag2. If associated Procedure Code Flag List (VVL) value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code3. If associated Procedure Code Flag List (VVL) value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code4. If associated Procedure Code Flag List (VVL) value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code5. Value must be 8 characters or less6. Value must be in Procedure Code List (VVL)7. Conditional
09/12/2024	3.29.0	CIP.002.069	UPDATE	Coding requirement	1. Value must be 4 characters or less2. The right-most 2 positions must be found in 01-993. Conditional4. Value must be populated, when associated Diagnosis Related Group (CIP.002.068) is populated	1. Value must be 4 characters or less2. The right-most 2 positions must be in [01-99]3. Conditional4. Value must be populated, when associated Diagnosis Related Group (CIP.002.068) is populated
09/12/2024	3.29.0	CIP.002.025	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Conditional5. When value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Conditional5. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated
09/12/2024	3.29.0	CIP.002.023	UPDATE	Coding requirement	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service)5. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported6. Conditional	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in [01,02,04,08,09,10] for the same time period (by date of service)5. If the Type of Claim value is in [1,3,A,C], then value is mandatory and must be reported6. Conditional
09/12/2024	3.29.0	CIP.002.022	UPDATE	Coding requirement	1. Mandatory2. Value must be 20 characters or less3. When Type of Claim not in (4, D, X, Z, U, V, Y, W), value must match MSIS Identification Number (ELG.021.251) and the Admission Date (CIP.002.094) must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)4. When Type of Claim (CIP.002.100) equals 4, D or X (lump sum payment) value must begin with an '&'	1. Mandatory2. Value must be 20 characters or less3. When Type of Claim not in [4,D,X,Z,U,V,Y,W], value must match MSIS Identification Number (ELG.021.251) and the Admission Date (CIP.002.094) must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)4. When Type of Claim (CIP.002.100) equals 4, D or X (lump sum payment) value must begin with an "&"
09/12/2024	3.29.0	CIP.002.020	UPDATE	Coding requirement	Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [‘4’, ‘1’] then value must be populated	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1] then value must be populated
09/12/2024	3.29.0	CIP.001.011	UPDATE	Coding requirement	1. For production files, value must be equal to 'P'2. Value must be in File Status Indicator List (VVL)3. Value must be 1 character4. Mandatory	1. For production files, value must be equal to "P"2. Value must be in File Status Indicator List (VVL)3. Value must be 1 character4. Mandatory
09/12/2024	3.29.0	CIP.001.006	UPDATE	Coding requirement	1. Value must equal 'CLAIM-IP'2. Mandatory	1. Value must equal "CLAIM-IP"2. Mandatory
09/07/2023	3.12.0	COT.003.184	UPDATE	Definition	The maximum allowable quantity of a service that may be rendered per date of service or per month. For use with CLAIMOT and CLAIMRX claims. For CLAIMIP and CLAIMOT claims/encounter records, use the Revenue center -quantity Allowed field. NOTE: One prescription for 100 250 milligram tablets results in Prescription Quantity allowed=100.This field is only applicable when the service being billed can be quantified in discrete units, e.g., a number of visits or the number of units of a prescription/refill that were filled. For prescriptions/refills, use the Medicaid Drug Rebate definition of a unit, which is the smallest unit by which the drug is normally measured; e.g. tablet, capsule, milliliter, etc. For drugs not identifiable or dispensed by a normal unit, e.g. powder filled vials, use 1 as the number of units. The value in Prescription Quantity allowed must correspond with the value in Unit of measure.	The maximum allowable quantity of a service that may be rendered per date of service or per month. For use with CLAIMOT and CLAIMRX claims. For CLAIMIP and CLAIMOT claims/encounter records, use the Revenue center -quantity Allowed field. NOTE: One prescription for 100 250 milligram tablets results in Prescription Quantity allowed=100. This field is only applicable when the service being billed can be quantified in discrete units, e.g., a number of visits or the number of units of a prescription/refill that were filled. For prescriptions/refills, use the Medicaid Drug Rebate definition of a unit, which is the smallest unit by which the drug is normally measured; e.g. tablet, capsule, milliliter, etc. For drugs not identifiable or dispensed by a normal unit, e.g. powder filled vials, use 1 as the number of units. The value in Prescription Quantity allowed must correspond with the value in Unit of measure.
11/15/2023	3.16.0	Data Quality Measures	UPDATE	Version text	3.9.0	3.10.0
09/06/2023	3.12.0	RULE-7411	ADD	N/A		Created
09/06/2023	3.12.0	RULE-7408	ADD	N/A		Created
09/06/2023	3.12.0	RULE-7407	ADD	N/A		Created
09/06/2023	3.12.0	RULE-7371	ADD	N/A		Created
09/06/2023	3.12.0	RULE-7370	ADD	N/A		Created
09/06/2023	3.12.0	RULE-7369	ADD	N/A		Created
09/06/2023	3.12.0	RULE-7368	ADD	N/A		Created
09/06/2023	3.12.0	RULE-7367	ADD	N/A		Created
09/06/2023	3.12.0	RULE-7366	ADD	N/A		Created
09/06/2023	3.12.0	RULE-7423	ADD	N/A		Created
09/06/2023	3.12.0	ALL-40-001-1	ADD	N/A		Created
09/06/2023	3.12.0	ALL-39-001-1	ADD	N/A		Created
09/06/2023	3.12.0	ALL-38-001-1	ADD	N/A		Created
09/06/2023	3.12.0	ALL-37-001-1	ADD	N/A		Created
09/06/2023	3.12.0	MCR-12-163-163	ADD	N/A		Created
09/06/2023	3.12.0	MCR-12-162-162	ADD	N/A		Created
09/06/2023	3.12.0	MCR-12-161-161	ADD	N/A		Created
09/06/2023	3.12.0	MCR-12-160-160	ADD	N/A		Created
09/06/2023	3.12.0	MCR-12-159-159	ADD	N/A		Created
09/06/2023	3.12.0	MCR-12-158-158	ADD	N/A		Created
09/06/2023	3.12.0	MCR-12-157-157	ADD	N/A		Created
09/06/2023	3.12.0	MCR-12-156-156	ADD	N/A		Created
09/06/2023	3.12.0	MIS-11-010_10-58	ADD	N/A		Created
09/06/2023	3.12.0	MCR-59R-004-16	ADD	N/A		Created
09/06/2023	3.12.0	MCR-59R-003-15	ADD	N/A		Created
09/06/2023	3.12.0	MCR-59R-002-14	ADD	N/A		Created
09/06/2023	3.12.0	MCR-59R-001-13	ADD	N/A		Created
09/06/2023	3.12.0	MCR-56R-001-1	ADD	N/A		Created
09/06/2023	3.12.0	EXP-41R-001-1	ADD	N/A		Created
09/06/2023	3.12.0	EXP-22R-009-9	ADD	N/A		Created
09/06/2023	3.12.0	EXP-37R-001-1-2	ADD	N/A		Created
09/06/2023	3.12.0	EXP-33R-001-1	ADD	N/A		Created
09/06/2023	3.12.0	EXP-29R-001-1	ADD	N/A		Created
09/06/2023	3.12.0	MCR-59P-004-16	ADD	N/A		Created
09/06/2023	3.12.0	MCR-59P-003-15	ADD	N/A		Created
09/06/2023	3.12.0	MCR-59P-002-14	ADD	N/A		Created
09/06/2023	3.12.0	MCR-59P-001-13	ADD	N/A		Created
09/06/2023	3.12.0	MCR-56P-001-1	ADD	N/A		Created
09/06/2023	3.12.0	EXP-41P-001-1	ADD	N/A		Created
09/06/2023	3.12.0	EXP-22P-009-9	ADD	N/A		Created
09/06/2023	3.12.0	EXP-37P-001-1-2	ADD	N/A		Created
09/06/2023	3.12.0	EXP-33P-001-1	ADD	N/A		Created
09/06/2023	3.12.0	EXP-29P-001-1	ADD	N/A		Created
09/06/2023	3.12.0	RULE-7641	ADD	N/A		Created
09/07/2023	3.12.0	Data Quality Measures	UPDATE	Version text	3.8.0	3.9.0
09/06/2023	3.12.0	Data Quality Measures	UPDATE	Thresholds document	250	253
09/21/2023	3.13.0	CRX.002.101	UPDATE	Coding requirement	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, must have an associated Third Party Copayment Amount4. Situational	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, must have an associated Third Party Copayment Amount4. Situational
09/21/2023	3.13.0	COT.002.143	UPDATE	Coding requirement	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, must have an associated Third Party Copayment Amount 4. Situational	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, must have an associated Third Party Copayment Amount4. Situational
09/21/2023	3.13.0	CLT.002.166	UPDATE	Coding requirement	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, must have an associated Third Party Copayment Amount 4. Situational	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, must have an associated Third Party Copayment Amount4. Situational
09/21/2023	3.13.0	CIP.002.219	UPDATE	Coding requirement	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, must have an associated Third Party Copayment Amount 4. Situational	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, must have an associated Third Party Copayment Amount4. Situational
08/28/2023	3.12.0	CLT.002.065	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must not be greater than Total Allowed Amount8. Value must be populated, when Type of Claim is in [‘1’, ‘A’]9. Value must not be populated or equal to ‘0.00’ when associated Claim Status is in ['26', '026', '87', '087', '542', '585', '654']10. Value should not be populated, when associated Type of Claim value is in [‘4’, ‘D’] 11. Value must be less than Total Allowed Amount12. Value must be populated when the associated Type of Claim (CLT.002.052) is in [‘5’, ‘E’]	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must not be greater than Total Allowed Amount8. Value must be populated, when Type of Claim is in [‘1’, ‘A’]9. Value must not be populated or equal to ‘0.00’ when associated Claim Status is in ['26', '026', '87', '087', '542', '585', '654']10. Value should not be populated, when associated Type of Claim value is in [‘4’, ‘D’] 11. Value must be less than Total Allowed Amount11. Value must be populated when the associated Type of Claim (CLT.002.052) is in [‘5’, ‘E’]
08/28/2023	3.12.0	COT.002.050	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must not be greater than Total Allowed Amount (COT.002.049)8. Value must not be populated or equal to ‘0.00’ when associated Claim Status is in ['26', '026', '87', '087', '542', '585', '654']9. Value should not be populated, when associated Type of Claim value is in [‘4’, ‘D’] 10. Value must not be greater than Total Allowed Amount (COT.002.049) 11. Value must be populated, when Type of Claim (COT.002.037) is in [‘2’, '5', ‘B’, 'E']	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must be populated, when Type of Claim is in [‘1’, ‘A’]8. Value must not be populated or equal to ‘0.00’ when associated Claim Status is in ['26', '026', '87', '087', '542', '585', '654']9. Value should not be populated, when associated Type of Claim value is in [‘4’, ‘D’] 10. Value must not be greater than Total Allowed Amount (COT.002.049) 11. Value must be populated, when Type of Claim (COT.002.037) is in [‘2’, '5', ‘B’, 'E']
09/21/2023	3.13.0	ELG.012.172	UPDATE	Segment key field identifier	Not Applicable	3
08/28/2023	3.12.0	ELG.012.172	UPDATE	Coding requirement	1. Value must have a corresponding value in Waiver Type (ELG.012.173)2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by a version number [0-9] in the 12th position 5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Value must have a corresponding value in Waiver Type (ELG.012.173)7. Mandatory	1. Value must have a corresponding value in Waiver Type (ELG.012.173)2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by a version number [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Mandatory
08/28/2023	3.12.0	ELG.012.172	UPDATE	Coding requirement	Value must have a corresponding value in Waiver Type (ELG.012.173)2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by a version number [0-9] in the 12th position 5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Value must have a corresponding value in Waiver Type (ELG.012.173)7. Mandatory	1. Value must have a corresponding value in Waiver Type (ELG.012.173)2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by a version number [0-9] in the 12th position 5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Value must have a corresponding value in Waiver Type (ELG.012.173)7. Mandatory
08/28/2023	3.12.0	ELG.012.172	UPDATE	Coding requirement	1. Value must have a corresponding value in Waiver Type (ELG.012.173)2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Value must have a corresponding value in Waiver Type (ELG.012.173)6. Mandatory	Value must have a corresponding value in Waiver Type (ELG.012.173)2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by a version number [0-9] in the 12th position 5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Value must have a corresponding value in Waiver Type (ELG.012.173)7. Mandatory
08/28/2023	3.12.0	MCR.003.050	UPDATE	Coding requirement	Must contain the '@' symbol2. May contain uppercase and lowercase Latin letters A to Z and a to z3. May contain digits 0-94. Must contain a dot '.' that is not the first or last character and provided that it does not appear consecutively5. Value must be 60 characters or less6. Situational	1. Must contain the '@' symbol2. May contain uppercase and lowercase Latin letters A to Z and a to z3. May contain digits 0-94. Must contain a dot '.' that is not the first or last character and provided that it does not appear consecutively5. Value must be 60 characters or less6. Situational
09/21/2023	3.13.0	ELG.009.140	UPDATE	Segment key field identifier	Not Applicable	3
09/21/2023	3.13.0	ELG.013.183	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	TPL.006.082	UPDATE	Medicaid valid value info		Zip Code List
09/21/2023	3.13.0	CRX.003.113	UPDATE	Segment key field identifier	Not Applicable	3
09/21/2023	3.13.0	CRX.002.020	UPDATE	Segment key field identifier	Not Applicable	3
09/21/2023	3.13.0	COT.003.159	UPDATE	Segment key field identifier	Not Applicable	3
09/21/2023	3.13.0	COT.002.020	UPDATE	Segment key field identifier	Not Applicable	3
09/21/2023	3.13.0	CLT.003.189	UPDATE	Segment key field identifier	Not Applicable	3
09/21/2023	3.13.0	CLT.002.020	UPDATE	Segment key field identifier	Not Applicable	3
09/21/2023	3.13.0	CIP.003.236	UPDATE	Segment key field identifier	Not Applicable	3
09/21/2023	3.13.0	CIP.002.020	UPDATE	Segment key field identifier	Not Applicable	3
08/28/2023	3.12.0	COT.002.146	UPDATE	Coding requirement	Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Service (COT.003.186) equals '121', value must not be populated5. Value must exist in the NPPES NPI data file	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Service (COT.003.186) equals '121', value must not be populated5. Value must exist in the NPPES NPI data file
09/21/2023	3.13.0	ELG.022.265	UPDATE	Segment key field identifier	Not Applicable	4
09/06/2023	3.12.0	TPL.001.002	UPDATE	Definition	A data element to capture the version of the T-MSIS data dictionary that was used to build the file. Use the version number specified on the Cover Sheet of the data dictionary".	A data element to capture the version of the T-MSIS data dictionary that was used to build the file.
09/06/2023	3.12.0	PRV.001.002	UPDATE	Definition	A data element to capture the version of the T-MSIS data dictionary that was used to build the file. Use the version number specified on the Cover Sheet of the data dictionary".	A data element to capture the version of the T-MSIS data dictionary that was used to build the file.
09/06/2023	3.12.0	MCR.001.002	UPDATE	Definition	A data element to capture the version of the T-MSIS data dictionary that was used to build the file. Use the version number specified on the Cover Sheet of the data dictionary".	A data element to capture the version of the T-MSIS data dictionary that was used to build the file.
09/06/2023	3.12.0	ELG.001.002	UPDATE	Definition	A data element to capture the version of the T-MSIS data dictionary that was used to build the file. Use the version number specified on the Cover Sheet of the data dictionary".	A data element to capture the version of the T-MSIS data dictionary that was used to build the file.
09/06/2023	3.12.0	CRX.001.002	UPDATE	Definition	A data element to capture the version of the T-MSIS data dictionary that was used to build the file. Use the version number specified on the Cover Sheet of the data dictionary".	A data element to capture the version of the T-MSIS data dictionary that was used to build the file.
09/06/2023	3.12.0	COT.001.002	UPDATE	Definition	A data element to capture the version of the T-MSIS data dictionary that was used to build the file. Use the version number specified on the Cover Sheet of the data dictionary".	A data element to capture the version of the T-MSIS data dictionary that was used to build the file.
09/06/2023	3.12.0	CLT.001.002	UPDATE	Definition	A data element to capture the version of the T-MSIS data dictionary that was used to build the file. Use the version number specified on the Cover Sheet of the data dictionary".	A data element to capture the version of the T-MSIS data dictionary that was used to build the file.
08/28/2023	3.12.0	CLT.001.002	UPDATE	Coding requirement	Value must be 10 characters or less2. Value must be in the Data Dictionary Version List (VVL)3. Mandatory	1. Value must be 10 characters or less2. Value must be in the Data Dictionary Version List (VVL)3. Mandatory
09/21/2023	3.13.0	CIP.001.002	UPDATE	Definition	A data element to capture the version of the T-MSIS data dictionary that was used to build the file. Use the version number specified on the Cover Sheet of the data dictionary".	A data element to capture the version of the T-MSIS data dictionary that was used to build the file.
08/28/2023	3.12.0	COT.002.137	UPDATE	Definition	Not Applicable	An indicator signifying that the copay was discounted or waived by the provider (e.g., physician or hospital). Do not use to indicate administrative-level, Medicaid State Agency or Medicaid MCO copayment waived decisions.
08/29/2023	3.12.0	CRX.002.101	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	CRX.002.101	UPDATE	Coding requirement	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, must have an associated Third Party Copayment Amount 4. Situational	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, must have an associated Third Party Copayment Amount4. Situational
08/29/2023	3.12.0	COT.002.143	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	CLT.002.166	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	CIP.002.219	UPDATE	Necessity	Optional	Situational
08/23/2023	3.12.0	CLT.002.166	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Third Party Copayment Amount4. Situational	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, must have an associated Third Party Copayment Amount 4. Situational
08/23/2023	3.12.0	CIP.002.219	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Third Party Copayment Amount4. Situational	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, must have an associated Third Party Copayment Amount 4. Situational
08/29/2023	3.12.0	CRX.002.100	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	COT.002.142	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	CLT.002.165	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	CIP.002.218	UPDATE	Necessity	Optional	Situational
09/21/2023	3.13.0	CRX.002.099	UPDATE	Coding requirement	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, value must have an associated Third Party Coinsurance Amount 4. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, value must have an associated Third Party Coinsurance Amount4. Conditional
09/21/2023	3.13.0	COT.002.141	UPDATE	Coding requirement	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, value must have an associated Third Party Coinsurance Amount 4. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, value must have an associated Third Party Coinsurance Amount4. Conditional
09/21/2023	3.13.0	CLT.002.164	UPDATE	Coding requirement	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, value must have an associated Third Party Coinsurance Amount 4. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, value must have an associated Third Party Coinsurance Amount4. Conditional
09/21/2023	3.13.0	CIP.002.217	UPDATE	Coding requirement	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, value must have an associated Third Party Coinsurance Amount 4. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, value must have an associated Third Party Coinsurance Amount4. Conditional
08/29/2023	3.12.0	CRX.002.098	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	COT.002.140	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	CLT.002.163	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	CIP.002.216	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	TPL.006.086	UPDATE	Necessity	Optional	Situational
08/21/2023	3.12.0	TPL.006.086	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/29/2023	3.12.0	TPL.005.070	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	TPL.004.061	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	TPL.003.050	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	TPL.002.027	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	TPL.001.014	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	PRV.010.136	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	PRV.009.123	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	PRV.008.113	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	PRV.007.104	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	PRV.006.092	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	PRV.005.082	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	PRV.004.070	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	PRV.003.058	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	PRV.002.037	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	PRV.001.014	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	MCR.007.089	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	MCR.006.080	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	MCR.005.071	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	MCR.004.061	UPDATE	Necessity	Optional	Situational
08/29/2023	3.12.0	MCR.003.052	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	MCR.002.032	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	MCR.001.014	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.022.267	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.021.255	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.020.245	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.018.236	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.017.227	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.016.218	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.015.207	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.014.198	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.013.186	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.012.176	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.011.166	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.010.157	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.009.144	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.008.134	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.007.124	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.006.112	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.005.101	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.004.077	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.003.059	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.002.028	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	ELG.001.014	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	CRX.003.153	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	CRX.002.106	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	CRX.001.014	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	COT.003.214	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	COT.002.152	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	COT.001.014	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	CLT.003.226	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	CLT.002.173	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	CLT.001.014	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	CIP.003.273	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	CIP.002.229	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	CIP.001.014	UPDATE	Necessity	Optional	Situational
08/16/2023	3.12.0	CIP.003.269	UPDATE	Coding requirement	1. Value must be in CMS 64 Category for Federal Reimbursement List (VVL)2. Value must be 2 characters3. (Federal Funding under Title XXI) if value equals '02', then the eligible's CHIP Code (ELG.003.054) must be in ['2', '3']4. (Federal Funding under Title XIX) if value equals '01' then the eligible's CHIP Code (ELG.003.054) must be '1'5. Conditional6. If Type of Claim is in ['1','2','5','A','B','E','U','V','Y'] and the Total Medicaid Paid Amount is populated on the corresponding claim header, then value must be reported7. If Type of Claim is in ['4','D'] and the Service Tracking Payment Amount on the relevant record is populated, then value must be reported8. When Type of Claim is in [‘1’, ‘A’], value must be populated	1. Value must be in CMS 64 Category for Federal Reimbursement List (VVL)2. Value must be 2 characters3. (Federal Funding under Title XXI) if value equals '02', then the eligible's CHIP Code (ELG.003.054) must be in ['2', '3']4. (Federal Funding under Title XIX) if value equals '01' then the eligible's CHIP Code (ELG.003.054) must be '1'5. Conditional6. If Type of Claim is in ['1','2','5','A','B','E','U','V','Y'] and the Total Medicaid Paid Amount is populated on the corresponding claim header, then value must be reported7. If Type of Claim is in ['4','D'] and the Service Tracking Payment Amount on the relevant record is populated, then value must be reported8. When Type of Claim is in [‘1’,‘A’], value must be populated
08/16/2023	3.12.0	CIP.003.269	UPDATE	Coding requirement	Value must be in CMS 64 Category for Federal Reimbursement List (VVL)2. Value must be 2 characters3. (Federal Funding under Title XXI) if value equals '02', then the eligible's CHIP Code (ELG.003.054) must be in ['2', '3']4. (Federal Funding under Title XIX) if value equals '01' then the eligible's CHIP Code (ELG.003.054) must be '1'5. Conditional6. If Type of Claim is in ['1','2','5','A','B','E','U','V','Y'] and the Total Medicaid Paid Amount is populated on the corresponding claim header, then value must be reported.7. If Type of Claim is in ['4','D'] and the Service Tracking Payment Amount on the relevant record is populated, then value must be reported.8. When Type of Claim is in [‘1’, ‘A’], value must be populated	1. Value must be in CMS 64 Category for Federal Reimbursement List (VVL)2. Value must be 2 characters3. (Federal Funding under Title XXI) if value equals '02', then the eligible's CHIP Code (ELG.003.054) must be in ['2', '3']4. (Federal Funding under Title XIX) if value equals '01' then the eligible's CHIP Code (ELG.003.054) must be '1'5. Conditional6. If Type of Claim is in ['1','2','5','A','B','E','U','V','Y'] and the Total Medicaid Paid Amount is populated on the corresponding claim header, then value must be reported7. If Type of Claim is in ['4','D'] and the Service Tracking Payment Amount on the relevant record is populated, then value must be reported8. When Type of Claim is in [‘1’, ‘A’], value must be populated
08/16/2023	3.12.0	COT.002.112	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.081) equal to '1' 5. When Type of Claim is in ['1','3','A','C'], then value must be populated 6. When Type of Claim in ('1','3','A','C’) then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in ['01', '02', '03', '04', '05', '06'] (active)7. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080) 9. When Type of Service (COT.003.186) is not in ['119', ‘120’, ‘122’], value must be reported in Provider Identifier (PRV.005.080) with an associated Provider Identifier Type (PRV.005.081) equal to '1'	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.081) equal to '1' 5. When Type of Claim is in ['1','3','A','C'], then value must be populated6. When Type of Claim in ('1','3','A','C’) then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in ['01', '02', '03', '04', '05', '06'] (active)7. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)9. When Type of Service (COT.003.186) is not in ['119', ‘120’, ‘122’], value must be reported in Provider Identifier (PRV.005.080) with an associated Provider Identifier Type (PRV.005.081) equal to '1'
08/16/2023	3.12.0	CRX.002.071	UPDATE	Coding requirement	1. Value must be 10 digits 2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2' 3. Value must exist in the NPPES NPI data file 4. Conditional 5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal '01' 6. When Type of Claim is in ['1','3','A','C'], then value must be populated 7. When Type of Claim not in ('3','C','W') then value must match Provider Identifier (PRV.002.081) 8. NPPES Entity Type Code associated with this NPI must equal ‘2’ (Organization)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2'3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal '01'6. When Type of Claim is in ['1','3','A','C'], then value must be populated7. When Type of Claim not in ('3','C','W') then value must match Provider Identifier (PRV.002.081) 8. NPPES Entity Type Code associated with this NPI must equal ‘2’ (Organization)
08/16/2023	3.12.0	CIP.002.180	UPDATE	Coding requirement	Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Value must exist in the NPPES NPI data file 4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal '01'6. When Type of Claim is in ['1','3','A','C'], then value must be populated 7. NPPES Entity Type Code associated with this NPI must equal ‘2’ (Organization)	1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal '01'6. When Type of Claim is in ['1','3','A','C'], then value must be populated7. NPPES Entity Type Code associated with this NPI must equal ‘2’ (Organization)
08/16/2023	3.12.0	COT.003.176	UPDATE	Coding requirement	1. Situational2. Value must be between -99999999999.99 and 99999999999.993. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )	1. Situational2. Value must be between -99999999999.99 and 99999999999.993. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )4. Value must be 11 digits or less left of the decimal i.e. 9999999999 99
09/21/2023	3.13.0	CRX.002.025	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	CRX.002.025	UPDATE	Coding requirement	Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’
09/21/2023	3.13.0	COT.002.025	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	COT.002.025	UPDATE	Coding requirement	Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’
09/21/2023	3.13.0	CLT.002.025	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	CLT.002.025	UPDATE	Coding requirement	Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’
09/21/2023	3.13.0	CIP.002.026	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	CIP.002.026	UPDATE	Coding requirement	Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’
08/28/2023	3.12.0	ELG.012.172	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Value must have a corresponding value in Waiver Type (ELG.012.173)6. Mandatory	1. Value must have a corresponding value in Waiver Type (ELG.012.173)2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Value must have a corresponding value in Waiver Type (ELG.012.173)6. Mandatory
08/28/2023	3.12.0	CRX.002.069	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by a version number [0-9] in the 12th position 5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Conditional
08/28/2023	3.12.0	COT.002.111	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by a version number [0-9] in the 12th position 5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Conditional
08/28/2023	3.12.0	CLT.002.129	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by a version number [0-9] in the 12th position 5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Conditional
08/28/2023	3.12.0	CIP.002.178	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by a version number [0-9] in the 12th position 5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]6. Conditional
09/06/2023	3.12.0	COT.003.205	UPDATE	Definition	The street address of the destination point to which a patient is transported either from home or Long term care facility to a health care provider for healthcare services or vice versa. For transportation claims only. Required if state has captured this information, otherwise it is conditional.	The second line of the street address of the destination point to which a patient is transported either from home or Long term care facility to a health care provider for healthcare services or vice versa. For transportation claims only. Required if state has captured this information, otherwise it is conditional.
08/14/2023	3.12.0	CIP.002.094	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be less than or equal to associated Discharge Date (CE) value in the claim header.4. Value must be greater than or equal to associated eligible Date of Birth (CE) value.5. Value must be less than or equal to associated eligible Date of Death (CE) value.6. Mandatory7. Value must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)8. (capitated payment) when associated Type of Claim (CIP.002.100) is not '2','B' or 'V' and Type of Service (CIP.002.257) is not '119, '120', '121', 122' value must be before Adjudication Date (CIP.003.286)	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be less than or equal to associated Discharge Date value in the claim header.4. Value must be greater than or equal to associated eligible Date of Birth value.5. Value must be less than or equal to associated eligible Date of Death value.6. Mandatory7. Value must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)8. (capitated payment) when associated Type of Claim (CIP.002.100) is not '2','B' or 'V' and Type of Service (CIP.002.257) is not '119, '120', '121', 122' value must be before Adjudication Date (CIP.003.286)
08/15/2023	3.12.0	CRX.002.025	UPDATE	Coding requirement	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory	Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’
08/28/2023	3.12.0	CRX.002.023	UPDATE	Coding requirement	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service)5. Value must be 1 character6. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported.7. Conditional	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service)5. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported.6. Conditional
09/21/2023	3.13.0	CRX.002.017	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	ELG.005.099	UPDATE	Segment key field identifier	Not Applicable	(a)
08/15/2023	3.12.0	CIP.002.026	UPDATE	Coding requirement	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory	Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’
08/28/2023	3.12.0	CIP.002.023	UPDATE	Coding requirement	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service)5. Value must be 1 character6. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported.7. Conditional	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service)5. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported6. Conditional
08/15/2023	3.12.0	CLT.002.025	UPDATE	Coding requirement	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory	Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’
08/28/2023	3.12.0	CLT.002.023	UPDATE	Coding requirement	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service)5. Value must be 1 character6. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported.7. Conditional	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service)5. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported.6. Conditional
09/21/2023	3.13.0	ELG.005.086	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	CLT.002.017	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	ELG.005.082	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	CIP.002.017	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	ELG.004.071	UPDATE	Medicaid valid value info		Zip Code List
08/15/2023	3.12.0	COT.002.025	UPDATE	Coding requirement	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory	Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’
08/28/2023	3.12.0	COT.002.023	UPDATE	Coding requirement	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service)5. Value must be 1 character6. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported.7. Conditional	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service)5. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported.6. Conditional
09/21/2023	3.13.0	COT.002.017	UPDATE	Segment key field identifier	Not Applicable	1
08/11/2023	3.11.0	CRX - CLAIM PHARMACY	UPDATE	File name	CRX - CLAIM PRESCRIPTION	CRX - CLAIM PHARMACY
08/15/2023	3.12.0	COT.003.175	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional4. When Type of Claim is in ['1', 'A'}, Medicaid Paid Amount (COT.003.177) is less than or equal to the value submitted
08/11/2023	3.11.0	COT.002.037	UPDATE	Definition	A code to indicate what type of payment is covered in this claim.For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.	A code to indicate what type of payment is covered in this claim.For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.For sub-capitation payments, report TYPE-OF-CLAIM = '6' or “F”.
08/28/2023	3.12.0	CRX.002.041	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must be populated, when Type of Claim is in [‘1’, ‘A’]8. Value must not be populated or equal to ‘0.00’ when associated Claim Status is in ['26', '026', '87', '087', '542', '585', '654']9. Value should not be populated, when associated Type of Claim value is in [‘4’, ‘D’]
08/28/2023	3.12.0	COT.002.050	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must not be greater than Total Allowed Amount (COT.002.049)	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must not be greater than Total Allowed Amount (COT.002.049)8. Value must not be populated or equal to ‘0.00’ when associated Claim Status is in ['26', '026', '87', '087', '542', '585', '654']9. Value should not be populated, when associated Type of Claim value is in [‘4’, ‘D’] 10. Value must not be greater than Total Allowed Amount (COT.002.049) 11. Value must be populated, when Type of Claim (COT.002.037) is in [‘2’, '5', ‘B’, 'E']
08/28/2023	3.12.0	CLT.002.065	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must not be greater than Total Allowed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must not be greater than Total Allowed Amount8. Value must be populated, when Type of Claim is in [‘1’, ‘A’]9. Value must not be populated or equal to ‘0.00’ when associated Claim Status is in ['26', '026', '87', '087', '542', '585', '654']10. Value should not be populated, when associated Type of Claim value is in [‘4’, ‘D’] 11. Value must be less than Total Allowed Amount12. Value must be populated when the associated Type of Claim (CLT.002.052) is in [‘5’, ‘E’]
08/28/2023	3.12.0	CIP.002.114	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must not be greater than Total Allowed Amount (CIP.002.113)	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must be populated, when Type of Claim is in [‘1’, ‘A’]8. Value must not be populated or equal to ‘0.00’ when associated Claim Status is in ['26', '026', '87', '087', '542', '585', '654']9. Value should not be populated, when associated Type of Claim value is in [‘4’, ‘D’] 10. Value must be populated when the associated Type of Claim (CIP.002.100) is in [‘5’, ‘E’]11. Value must not be greater than Total Allowed Amount (CIP.002.113)
08/28/2023	3.12.0	CRX.002.039	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. Value should not be populated when associated Type of Claim is in [2, 4, 5, B, D E or X]	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. When associated Type of Claim in [‘1’, ’3’, ’A’, ’C’], value must be populated
08/28/2023	3.12.0	COT.002.048	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. Value should not be populated when associated Type of Claim is in [2, 4, 5, B, D E or X]	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. When associated Type of Claim in [‘1’, ’3’, ’A’, ’C’], value must be populated
08/28/2023	3.12.0	CLT.002.063	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. Value should not be populated when associated Type of Claim is in [2, 4, 5, B, D E or X]6. Value should not be populated when associated Type of Claim (CIP.002.100) is equal to '4', 'D' or 'X'7. (individual line item payments) when populated and Payment Level Indicator (CLT.002.082) equals = '2' value must be greater than or equal to the sum of all claim line Revenue Charges (CLT.003.204)	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. When associated Type of Claim in [‘1’, ’3’, ’A’, ’C’], value must be populated 6. Value should not be populated when associated Type of Claim (CLT.002.052) is equal to '4', 'D' or 'X'7. (individual line item payments) when populated and Payment Level Indicator (CLT.002.082) equals = '2' value must be greater than or equal to the sum of all claim line Revenue Charges (CLT.003.204)
08/28/2023	3.12.0	CIP.002.112	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. Value should not be populated when associated Type of Claim is in [2, 4, 5, B, D E or X]6. (individual line item payments) when populated and Payment Level Indicator (CIP.002.132) equals = '2' value must be greater than or equal to the sum of all claim line Revenue Charges (CIP.003.251)	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. When associated Type of Claim in [‘1’, ’3’, ’A’, ’C’], value must be populated6. (individual line item payments) when populated and Payment Level Indicator (CIP.002.132) equals = '2' value must be greater than or equal to the sum of all claim line Revenue Charges (CIP.003.251)
08/09/2023	3.11.0	CIP.002.112	UPDATE	Definition	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider.	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/15/2023	3.12.0	CLT.003.204	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than or equal to associated Total Billed Amount (CE) value.4. When populated, associated claim line Revenue Charge must be populated5. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than or equal to associated Total Billed Amount value.4. When populated, associated claim line Revenue Charge must be populated5. Conditional
08/15/2023	3.12.0	CIP.003.251	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than or equal to associated Total Billed Amount (CE) value.4. When populated, associated claim line Revenue Charge must be populated5. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than or equal to associated Total Billed Amount value4. When populated, associated claim line Revenue Charge must be populated5. Conditional
09/01/2023	3.12.0	COT.003.178	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional4. Value should not be populated or equal to zero, when associated Claim Line Status is in ['26', '026', '87', '087', '542', '585', '654']
09/01/2023	3.12.0	CLT.003.208	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional4. Value should not be populated or equal to zero, when associated Claim Line Status is in ['26', '026', '87', '087', '542', '585', '654']
09/01/2023	3.12.0	CIP.003.254	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional4. Value should not be populated or equal to zero, when associated Claim Line Status is in ['26', '026', '87', '087', '542', '585', '654']
08/16/2023	3.12.0	COT.002.112	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier where the Provider Identifier5. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)7. When Type of Service (COT.003.186) is not in ['119', '120', '122'], value must be reported in Provider Identifier (PRV.005.080) with an associated Provider Identifier Type (PRV.005.081) equal to '1'	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.081) equal to '1' 5. When Type of Claim is in ['1','3','A','C'], then value must be populated 6. When Type of Claim in ('1','3','A','C’) then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in ['01', '02', '03', '04', '05', '06'] (active)7. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080) 9. When Type of Service (COT.003.186) is not in ['119', ‘120’, ‘122’], value must be reported in Provider Identifier (PRV.005.080) with an associated Provider Identifier Type (PRV.005.081) equal to '1'
08/09/2023	3.11.0	ELG.005.095	UPDATE	Definition	The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another. Do not populate if at the time someone loses Medicaid eligibility they become eligible for and enrolled in CHIP. Also do not populate if at the time someone loses CHIP eligibility they become eligible for and enrolled in Medicaid.\|	The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another. Do not populate if at the time someone loses Medicaid eligibility they become eligible for and enrolled in CHIP. Also do not populate if at the time someone loses CHIP eligibility they become eligible for and enrolled in Medicaid.
09/21/2023	3.13.0	CRX.003.116	UPDATE	Segment key field identifier	Not Applicable	6
09/21/2023	3.13.0	COT.003.162	UPDATE	Segment key field identifier	Not Applicable	6
09/21/2023	3.13.0	CLT.003.192	UPDATE	Segment key field identifier	Not Applicable	6
09/21/2023	3.13.0	CIP.003.239	UPDATE	Segment key field identifier	Not Applicable	6
08/22/2023	3.12.0	ELG.016.215	UPDATE	Definition	"American Indian or Alaska Native" means any individual defined at 25 USC 1603(13), 1603(28), or 1679(a), or who has been determined eligible as an Indian, pursuant to 42 CFR 136.12. This means the individual: a. Is a member of a Federally-recognized Indian tribe; b. Resides in an urban center and meets one or more of the following four criteria: i. Is a member of a tribe, band, or other organized group of Indians, including those tribes, bands, or groups terminated since 1940 and those recognized now or in the future by the State in which they reside, or who is a descendant, in the first or second degree, of any such member; ii. Is an Eskimo or Aleut or other Alaska Native; iii. Is considered by the Secretary of the Interior to be an Indian for any purpose; or iv. Is determined to be an Indian under regulations promulgated by the `Secretary of Health and Human Services; c. Is considered by the Secretary of the Interior to be an Indian for any purpose; or d. Is considered by the Secretary of Health and Human Services to be an Indian for purposes of eligibility for Indian health care services, including as a California Indian, Eskimo, Aleut, or other Alaska Native. NOTE Applicants who complete Appendix B of the Marketplace/Medicaid application and respond affirmatively to the two questions shown below are considered to meet the definition of an American Indian/Alaskan Native. Are you a member of a federally recognized tribe? Has this person ever gotten a service from the Indian Health Service, a tribal health program, or urban Indian health program, or through a referral from one of these programs?	"American Indian or Alaska Native" means any individual defined at 25 USC 1603(13), 1603(28), or 1679(a), or who has been determined eligible as an Indian, pursuant to 42 CFR 136.12. This means the individual: a. Is a member of a Federally-recognized Indian tribe; b. Resides in an urban center and meets one or more of the following four criteria: i. Is a member of a tribe, band, or other organized group of Indians, including those tribes, bands, or groups terminated since 1940 and those recognized now or in the future by the State in which they reside, or who is a descendant, in the first or second degree, of any such member; ii. Is an Eskimo or Aleut or other Alaska Native; iii. Is considered by the Secretary of the Interior to be an Indian for any purpose; or iv. Is determined to be an Indian under regulations promulgated by the Secretary of Health and Human Services; c. Is considered by the Secretary of the Interior to be an Indian for any purpose; or d. Is considered by the Secretary of Health and Human Services to be an Indian for purposes of eligibility for Indian health care services, including as a California Indian, Eskimo, Aleut, or other Alaska Native. NOTE Applicants who complete Appendix B of the Marketplace/Medicaid application and respond affirmatively to the two questions shown below are considered to meet the definition of an American Indian/Alaskan Native. Are you a member of a federally recognized tribe? Has this person ever gotten a service from the Indian Health Service, a tribal health program, or urban Indian health program, or through a referral from one of these programs?
09/21/2023	3.13.0	ELG.018.233	UPDATE	Segment key field identifier	Not Applicable	3
08/07/2023	3.11.0	COT.002.136	UPDATE	Coding requirement	1. Value must be in Claim Denied Indicator List (VVL)2. If value is '0', then Claim Status Category (CE) must equal "F2"3. Value must be 1 character4. Mandatory	1. Value must be in Claim Denied Indicator List (VVL)2. If value is '0', then Claim Status Category must equal "F2"3. Value must be 1 character4. Mandatory
08/28/2023	3.12.0	CLT.003.225	UPDATE	Coding requirement	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '2', then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '02', then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less
08/28/2023	3.12.0	CLT.003.224	UPDATE	Coding requirement	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is '1', then a valid value is mandatory and must be reported5. If value is in ['14', '35', '42' or '44'], then Sex (ELG.002.023) must not equals 'M'6. If XXI MBESCBES Category of Service is populated then must not be populated	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is '01', then a valid value is mandatory and must be reported5. If value is in ['14', '35', '42' or '44'], then Sex (ELG.002.023) must not equals 'M'6. If XXI MBESCBES Category of Service is populated then must not be populated
08/07/2023	3.11.0	CRX.002.025	UPDATE	Coding requirement	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim (CE) value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim (CE) value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory
08/09/2023	3.11.0	COT.002.112	UPDATE	Definition	A unique identification number assigned by the state to a provider or capitation plan. This data element should represent the entity billing for the service. For encounter records, if associated Type of Claim value equals 3, C, or W, then value must be the state identifier of the provider or entity (billing or reporting) to the managed care plan.	A unique identification number assigned by the state to a provider or capitation plan. This data element should represent the entity billing for the service. For encounter records, if associated Type of Claim value equals 3, C, or W, then value must be the state identifier of the provider or entity (billing or reporting) to the managed care plan.For sub-capitation payments, report the state-assigned provider identifier for the sub-capitated entity, when available or required.
08/15/2023	3.12.0	COT.002.111	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type (CE)2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Conditional
08/07/2023	3.11.0	CIP.002.212	UPDATE	Coding requirement	1. Value must be in Claim Denied Indicator List (VVL)2. If value is '0', then Claim Status Category (CE) must equal "F2"3. Value must be 1 character4. Mandatory	1. Value must be in Claim Denied Indicator List (VVL)2. If value is '0', then Claim Status Category must equal "F2"3. Value must be 1 character4. Mandatory
08/28/2023	3.12.0	CRX.003.150	UPDATE	Coding requirement	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is '1', then a valid value is mandatory and must be reported5. If value is in ['14', '35', '42' or '44'], then Sex (ELG.002.023) must not equals 'M'6. If XXI MBESCBES Category of Service is populated then must not be populated	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is '01', then a valid value is mandatory and must be reported5. If value is in ['14', '35', '42' or '44'], then Sex (ELG.002.023) must not equals 'M'6. If XXI MBESCBES Category of Service is populated then must not be populated
08/28/2023	3.12.0	CRX.003.151	UPDATE	Coding requirement	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '2', then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '02', then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less
08/16/2023	3.12.0	CIP.002.179	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier where the Provider Identifier5. Discharge Date (CIP.002.096) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CIP.002.096) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier where the Provider Identifier5. Discharge Date (CIP.002.096) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CIP.002.096) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)7. Discharge Date (CIP.002.096) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Discharge Date (CIP.002.096) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)
08/28/2023	3.12.0	COT.003.212	UPDATE	Coding requirement	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '2', then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '02', then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less
08/28/2023	3.12.0	COT.003.211	UPDATE	Coding requirement	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is '1', then a valid value is mandatory and must be reported5. If value is in ['14', '35', '42' or '44'], then Sex (ELG.002.023) must not equals 'M'6. If XXI MBESCBES Category of Service is populated then must not be populated	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is '01', then a valid value is mandatory and must be reported5. If value is in ['14', '35', '42' or '44'], then Sex (ELG.002.023) must not equals 'M'6. If XXI MBESCBES Category of Service is populated then must not be populated
08/07/2023	3.11.0	CLT.002.025	UPDATE	Coding requirement	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim (CE) value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim (CE) value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory
08/07/2023	3.11.0	CIP.002.026	UPDATE	Coding requirement	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim (CE) value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim (CE) value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory
08/07/2023	3.11.0	CLT.002.159	UPDATE	Coding requirement	1. Value must be in Claim Denied Indicator List (VVL)2. If value is '0', then Claim Status Category (CE) must equal "F2"3. Value must be 1 character4. Mandatory	1. Value must be in Claim Denied Indicator List (VVL)2. If value is '0', then Claim Status Category must equal "F2"3. Value must be 1 character4. Mandatory
08/07/2023	3.11.0	CRX.002.094	UPDATE	Coding requirement	1. Value must be in Claim Denied Indicator List (VVL)2. If value is '0', then Claim Status Category (CE) must equal "F2"3. Value must be 1 character4. Mandatory	1. Value must be in Claim Denied Indicator List (VVL)2. If value is '0', then Claim Status Category must equal "F2"3. Value must be 1 character4. Mandatory
08/16/2023	3.12.0	CLT.002.130	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier where the Provider Identifier5. Ending Date of Service (CLT.002.049) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Ending Date of Service (CLT.002.049) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier where the Provider Identifier5. Ending Date of Service (CLT.002.049) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Ending Date of Service (CLT.002.049) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)7. Ending Date of Service (CLT.002.049) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Ending Date of Service (CLT.002.049) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)
08/28/2023	3.12.0	CIP.003.271	UPDATE	Coding requirement	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '2', then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '02', then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less
08/28/2023	3.12.0	CIP.003.270	UPDATE	Coding requirement	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is '1', then a valid value is mandatory and must be reported5. If value is in ['14', '35', '42' or '44'], then Sex (ELG.002.023) must not equals 'M'6. If XXI MBESCBES Category of Service is populated then must not be populated	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is '01', then a valid value is mandatory and must be reported5. If value is in ['14', '35', '42' or '44'], then Sex (ELG.002.023) must not equals 'M'6. If XXI MBESCBES Category of Service is populated then must not be populated
08/07/2023	3.11.0	COT.002.025	UPDATE	Coding requirement	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim (CE) value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim (CE) value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory	1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory
08/16/2023	3.12.0	CRX.002.070	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier where the Provider Identifier5. Prescription Fill Date (CRX.002.085) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Prescription Fill Date (CRX.002.085) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.081) equal to '1' 5. When Type of Claim is in ['1','3','A','C'], then value must be populated 6. When Type of Claim in ('1','3','A','C’) then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in ['01', '02', '03', '04', '05', '06'] (active)7. Prescription Fill Date (CRX.002.085) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or 8. Prescription Fill Date (CRX.002.085) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)
09/21/2023	3.13.0	PRV.007.100	UPDATE	Segment key field identifier	Not Applicable	3
09/21/2023	3.13.0	PRV.007.098	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	ELG.009.139	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	TPL.005.066	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	TPL.003.032	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	TPL.002.019	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.022.260	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.021.251	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.020.241	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.018.232	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.017.223	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.016.212	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.015.203	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.014.191	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.013.181	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.012.171	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.011.162	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.010.149	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.008.129	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.007.117	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.006.106	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.004.064	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.003.033	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	ELG.002.019	UPDATE	Segment key field identifier	Not Applicable	2
07/12/2023	3.10.0	CIP.002.194	UPDATE	Coding requirement	Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'4. Conditional
07/12/2023	3.10.0	CIP.002.194	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be populated, if Outlier Code (CIP.002.197) equals '00' or '09'4. Conditional	Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'4. Conditional
07/12/2023	3.10.0	CRX.002.081	UPDATE	Coding requirement	1. Value must be 30 characters or less2. First five (5) characters of the value must be a Julian date express in the form YYDDD (e.g. 19095, 95th day of 20(19))3. Value must not contain a pipe or asterisk symbols4. Mandatory	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Mandatory
07/12/2023	3.10.0	COT.002.126	UPDATE	Coding requirement	1. Value must be 30 characters or less2. First five (5) characters of the value must be a Julian date express in the form YYDDD (e.g. 19095, 95th day of 20(19))3. Value must not contain a pipe or asterisk symbols4. Mandatory	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Mandatory
07/12/2023	3.10.0	CLT.002.144	UPDATE	Coding requirement	1. Value must be 30 characters or less2. First five (5) characters of the value must be a Julian date express in the form YYDDD (e.g. 19095, 95th day of 20(19))3. Value must not contain a pipe or asterisk symbols4. Mandatory	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Mandatory
07/12/2023	3.10.0	CIP.002.202	UPDATE	Coding requirement	1. Value must be 30 characters or less2. First five (5) characters of the value must be a Julian date express in the form YYDDD (e.g. 19095, 95th day of 20(19))3. Value must not contain a pipe or asterisk symbols4. Mandatory	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Mandatory
08/16/2023	3.12.0	ELG.003.040	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1, 2] or not populated3. Value must be in Citizenship Indicator List (VVL)4. If value is coded as '0', then associated Immigration Status (ELG.003.042) value must be in [ 1, 2, 3 ]5. If value is coded as '1', then associated Immigration Status (ELG.003.042) value must equal '8'6. Value must be 1 character7. Mandatory	1. Value must be 1 character2. Value must be in Citizenship Indicator List (VVL)3. If value is coded as '0', then associated Immigration Status (ELG.003.042) value must be in [ 1, 2, 3 ]4. If value is coded as '1', then associated Immigration Status (ELG.003.042) value must equal '8'5. Mandatory
08/15/2023	3.12.0	ELG.009.270	UPDATE	Coding requirement	1. Value must be 3 characters2. Conditional3. Must be a 3 digit value from the Type-of-Service valid value list	1. Value must be 3 characters2. Conditional3. Must be a 3 digit value from the Type-of-Service (VVL)
07/12/2023	3.10.0	ELG.005.097	UPDATE	Coding requirement	Value must be in Restricted Benefits Code List (VVL)2. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "05", then Eligibility Group (ELG.005.087) must be "24"3. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "06", then Eligibility Group (ELG.005.087) must be "26"4. (Restricted Benefits) if value is "1" and Dual Eligible Code (ELG.005.085) value is "02", then Eligibility Group (ELG.005.087) must be "23"5. (Restricted Benefits) if value is "1" and Dual Eligible Code (ELG.005.085) value is "04", then Eligibility Group (ELG.005.087) must be "25"6. (Restricted Benefits) if value is "3", then Dual Eligible Code (ELG.005.085) cannot be "00"7. Mandatory8. If value is populated, then Eligibility Group (ELG.005.087) must be populated.9. If value is "6" then Eligibility Group(ELG.DE.087) must be in ("35", "70")10. If value is "1" or "7" then Eligibility Group (EGL.DE.087) must be in ("72", "73", "74", "75") and State Plan Option Type (ELG.DE.163) must equal to "06"11. (Restricted Pregnancy-Related) if value is "4", then associated Sex (ELG.002.023) value must be "F"12. (Non-Citizen) if value is "2", then associated Citizenship Indicator (ELG.003.040) value must not be equal to "1"13. If value is "D", there must be a corresponding MFP enrollment segment (ELG00010) with Effective and End dates that are within the timespan of this segment14. Value must be 1 character15. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "01", then Eligibility Group (ELG.005.087) must be "23"16. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "03", then Eligibility Group (ELG.005.087) must be "25"17. (Restricted Benefits) if value is "G", then Dual Eligible Code (ELG.005.085) must be in (‘01’, ‘03', ‘06’)	1. Value must be in Restricted Benefits Code List (VVL)2. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "05", then Eligibility Group (ELG.005.087) must be "24"3. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "06", then Eligibility Group (ELG.005.087) must be "26"4. (Restricted Benefits) if value is "1" and Dual Eligible Code (ELG.005.085) value is "02", then Eligibility Group (ELG.005.087) must be "23"5. (Restricted Benefits) if value is "1" and Dual Eligible Code (ELG.005.085) value is "04", then Eligibility Group (ELG.005.087) must be "25"6. (Restricted Benefits) if value is "3", then Dual Eligible Code (ELG.005.085) cannot be "00"7. Mandatory8. If value is populated, then Eligibility Group (ELG.005.087) must be populated.9. If value is "6" then Eligibility Group(ELG.DE.087) must be in ("35", "70")10. If value is "1" or "7" then Eligibility Group (EGL.DE.087) must be in ("72", "73", "74", "75") and State Plan Option Type (ELG.DE.163) must equal to "06"11. (Restricted Pregnancy-Related) if value is "4", then associated Sex (ELG.002.023) value must be "F"12. (Non-Citizen) if value is "2", then associated Citizenship Indicator (ELG.003.040) value must not be equal to "1"13. If value is "D", there must be a corresponding MFP enrollment segment (ELG00010) with Effective and End dates that are within the timespan of this segment14. Value must be 1 character15. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "01", then Eligibility Group (ELG.005.087) must be "23"16. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "03", then Eligibility Group (ELG.005.087) must be "25"17. (Restricted Benefits) if value is "G", then Dual Eligible Code (ELG.005.085) must be in (‘01’, ‘03', ‘06’)
09/21/2023	3.13.0	PRV.009.120	UPDATE	Segment key field identifier	Not Applicable	4
08/09/2023	3.11.0	COT.002.113	UPDATE	Definition	The National Provider ID (NPI) of the billing entity responsible for billing a patient for healthcare services. The billing provider can also be servicing, referring, or prescribing provider. Can be admitting provider except for Long Term Care.	The National Provider ID (NPI) of the billing entity responsible for billing a patient for healthcare services. The billing provider can also be servicing, referring, or prescribing provider. Can be admitting provider except for Long Term Care.For sub-capitation payments, report the national provider identifier (NPI) for the sub-capitated entity if the provider has one.
08/16/2023	3.12.0	CLT.002.131	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Claim (CLT.002.052) not in ('3','C','W') then value must match Provider Identifier (PRV.002.081)	1. Value must be 10 digits 2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2' 3. Value must exist in the NPPES NPI data file 4. Conditional 5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal '01' 6. When Type of Claim is in ['1','3','A','C'], then value must be populated 7. When Type of Claim not in ('3','C','W'), then value must match Provider Identifier (PRV.002.081) 8. NPPES Entity Type Code associated with this NPI must equal ‘2’ (Organization)
08/16/2023	3.12.0	CRX.002.071	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Claim not in ('3','C','W') then value must match Provider Identifier (PRV.002.081)	1. Value must be 10 digits 2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2' 3. Value must exist in the NPPES NPI data file 4. Conditional 5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal '01' 6. When Type of Claim is in ['1','3','A','C'], then value must be populated 7. When Type of Claim not in ('3','C','W') then value must match Provider Identifier (PRV.002.081) 8. NPPES Entity Type Code associated with this NPI must equal ‘2’ (Organization)
08/16/2023	3.12.0	CIP.002.180	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal '01'	Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Value must exist in the NPPES NPI data file 4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal '01'6. When Type of Claim is in ['1','3','A','C'], then value must be populated 7. NPPES Entity Type Code associated with this NPI must equal ‘2’ (Organization)
06/02/2023	3.8.0	RULE-7247	ADD	N/A		Created
06/02/2023	3.8.0	RULE-7251	ADD	N/A		Created
06/02/2023	3.8.0	RULE-7250	ADD	N/A		Created
06/02/2023	3.8.0	RULE-7249	ADD	N/A		Created
06/02/2023	3.8.0	RULE-7248	ADD	N/A		Created
06/02/2023	3.8.0	RULE-7246	ADD	N/A		Created
06/02/2023	3.8.0	RULE-7245	ADD	N/A		Created
06/02/2023	3.8.0	RULE-7244	ADD	N/A		Created
06/02/2023	3.8.0	RULE-7243	ADD	N/A		Created
06/02/2023	3.8.0	ALL-16-015-15	ADD	N/A		Created
06/02/2023	3.8.0	ALL-16-014-14	ADD	N/A		Created
06/02/2023	3.8.0	ALL-16-013-13	ADD	N/A		Created
06/02/2023	3.8.0	ALL-16-012-12	ADD	N/A		Created
06/02/2023	3.8.0	ALL-16-011-11	ADD	N/A		Created
06/02/2023	3.8.0	ALL-16-010-10	ADD	N/A		Created
06/02/2023	3.8.0	ALL-16-009-9	ADD	N/A		Created
09/06/2023	3.12.0	EL-3-029-38	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: RESTRICTED-BENEFITS-CODE = "4"Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with RESTRICTED-BENEFITS-CODE = "4"STEP 4: SEX = "M"Of the MSIS IDs that meet the criteria from STEP 3, further refine the population by keeping records with with SEX = "M"STEP 5: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 4 by the count of MSIS IDs from STEP 1	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: RESTRICTED-BENEFITS-CODE = "4"Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with RESTRICTED-BENEFITS-CODE = "4"STEP 4: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: SEX = "M"Of the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with with SEX = "M"STEP 6: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 5 by the count of MSIS IDs from STEP 1
06/02/2023	3.8.0	EL-3-029-38	ADD	N/A		Created
09/06/2023	3.12.0	EL-3-028-37	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Pregnancy Indicator = "1"Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with PREGNANCY-INDICATOR= "1" STEP 4: SEX = "M"Of the MSIS IDs that meet the criteria from STEP 3, further refine the population by keeping records with with SEX = "M"STEP 5: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 4 by the count of MSIS IDs from STEP 1	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHICS-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Pregnancy Indicator = "1"Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with PREGNANCY-INDICATOR= "1"STEP 4: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: SEX = "M"Of the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with with SEX = "M"STEP 6: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 5 by the count of MSIS IDs from STEP 1
06/02/2023	3.8.0	EL-3-028-37	ADD	N/A		Created
06/02/2023	3.8.0	EXP-13-004_1-7	ADD	N/A		Created
06/02/2023	3.8.0	EXP-13-003_1-6	ADD	N/A		Created
09/06/2023	3.12.0	Data Quality Measures	UPDATE	Thresholds document	212	250
09/06/2023	3.12.0	Data Quality Measures	UPDATE	Measures specification	213	251
09/06/2023	3.12.0	Data Quality Measures	UPDATE	Threshold and measures combined	225	252
09/07/2023	3.12.0	COT.003.186	UPDATE	Definition	A code to categorize the services provided to a Medicaid or CHIP enrollee.	A code to categorize the services provided to a Medicaid or CHIP enrollee. For sub-capitation payments, report a TYPE-OF-SERVICE value 119, 120, or 122.
06/02/2023	3.8.0	CIP.003.257	UPDATE	Coding requirement	1. Value must be 3 characters2. Mandatory3. Value must not equal '086' if Sex (ELG.002.023) equals 'M'4. Value must be in ['001', '058', '060', '084', '086', '090', '091', '092', '093', '123', '132', '135', '136', '137'] when associated Claim Type is CIP (Inpatient Claim)	1. Value must be 3 characters2. Mandatory3. Value must not equal '086' if Sex (ELG.002.023) equals 'M'4. Value must be in ['001', '058', '060', '084', '086', '090', '091', '092', '093', '123', '132', '135', '136', '137']
06/02/2023	3.8.0	CRX.002.053	UPDATE	Coding requirement	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional
06/02/2023	3.8.0	CLT.002.076	UPDATE	Coding requirement	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional
08/15/2023	3.12.0	COT.002.229	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2'3. Conditional4. Value must exist in the NPPES NPI data file
06/01/2023	3.8.0	COT.002.229	UPDATE	Definition	A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\|Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm).The NPI of Ordering Provider represents the individual who requested the service or items being reported on this service line. Example include, but are not limited to, provider ordering diagnostic tests and medical equipment or supplies.[Ordering provider information is only captured at the line level in the X12 837P format but in v3.0.0 of the T-MSIS file layout it is only captured at the header level. This discrepancy will be addressed in a future version of the T-MSIS OT file layout. Until Ordering provider information has been moved from the T-MSIS claim header to the line, there is no need to report it at the header.]	The NPI of Ordering Provider represents the individual who requested the service or items being reported on this service line. Example include, but are not limited to, provider ordering diagnostic tests and medical equipment or supplies.[Ordering provider information is only captured at the line level in the X12 837P format but in v3.0.0 of the T-MSIS file layout it is only captured at the header level. This discrepancy will be addressed in a future version of the T-MSIS OT file layout. Until Ordering provider information has been moved from the T-MSIS claim header to the line, there is no need to report it at the header.]
06/02/2023	3.8.0	CRX.002.054	UPDATE	Coding requirement	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional
06/02/2023	3.8.0	COT.002.063	UPDATE	Coding requirement	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional
06/02/2023	3.8.0	CLT.002.077	UPDATE	Coding requirement	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional
06/02/2023	3.8.0	CIP.002.127	UPDATE	Coding requirement	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional
06/02/2023	3.8.0	CRX.002.053	UPDATE	Coding requirement	Value must be in Funding Code List (VVL)2. Value must be 1 character3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional
06/02/2023	3.8.0	COT.002.062	UPDATE	Coding requirement	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional
06/02/2023	3.8.0	CLT.002.076	UPDATE	Coding requirement	Value must be in Funding Code List (VVL)2. Value must be 1 character3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional
06/02/2023	3.8.0	CIP.002.126	UPDATE	Coding requirement	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional
06/02/2023	3.8.0	CRX.003.134	UPDATE	Coding requirement	1. Value must be 3 characters2. Mandatory3. Value must be in ['011', '018', '033', '034', '036', '085', '089', '127', '131', '136', '137', '145'] when associated Claim Type is CRX (RX Claim)	1. Value must be 3 characters2. Mandatory3. Value must be in ['011', '018', '033', '034', '036', '085', '089', '127', '131', '136', '137', '145']
06/02/2023	3.8.0	COT.003.186	UPDATE	Coding requirement	1. Value must be 3 characters2. Mandatory3. When value is in [119-122], Servicing Provider NPI Num (COT.002.190) should not be populated4. Value must be in ['002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '127', '131', '134', '135', '136', '137', '138', '139', '140', '141', '142', '143', '144', '145', '147'] when associated Claim Type is COT (Other Claim)5. When value is in [119-122], Servicing Provider Taxonomy (COT.003.191) should not be populated6. When value is in [119-122], Referring Provider NPI Num (COT.002.118) should not be populated7. Value must be 3 characters8. Mandatory9. When value is in [119-122], Billing Provider NPI Num (COT.002.113) should not be populated10. When value is in [119-122], Billing Provider Taxonomy (COT.002.114) should not be populated11. When value is in [119-122], Referring Provider Taxonomy (COT.002.119) should not be populated12. When value is not in ['025','085'], Sex (ELG.002.023) equals 'M'13. When value is in [119-122], Servicing Provider Num (COT.002.189) should not be populated	1. Value must be 3 characters2. Mandatory3. When value is in [119-122], Servicing Provider NPI Num (COT.002.190) should not be populated4. Value must be in ['002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '127', '131', '134', '135', '136', '137', '138', '139', '140', '141', '142', '143', '144', '145', '147']5. When value is in [119-122], Servicing Provider Taxonomy (COT.003.191) should not be populated6. When value is in [119-122], Referring Provider NPI Num (COT.002.118) should not be populated7. Value must be 3 characters8. Mandatory9. When value is in [119-122], Billing Provider NPI Num (COT.002.113) should not be populated10. When value is in [119-122], Billing Provider Taxonomy (COT.002.114) should not be populated11. When value is in [119-122], Referring Provider Taxonomy (COT.002.119) should not be populated12. When value is not in ['025','085'], Sex (ELG.002.023) equals 'M'13. When value is in [119-122], Servicing Provider Num (COT.002.189) should not be populated
06/02/2023	3.8.0	CLT.003.211	UPDATE	Coding requirement	1. Value must be 3 characters2. Mandatory3. Value must be in ['009', '044', '045', '046', '047', '048', '050', '059', '133', '136', '137', '146', '147'] when associated Claim Type is CLT (Long Term Claim)	1. Value must be 3 characters2. Mandatory3. Value must be in ['009', '044', '045', '046', '047', '048', '050', '059', '133', '136', '137', '146', '147']
06/02/2023	3.8.0	CIP.003.257	UPDATE	Coding requirement	Value must be 3 characters2. Mandatory3. Value must not equal '086' if Sex (ELG.002.023) equals 'M'4. Value must be in ['001', '058', '060', '084', '086', '090', '091', '092', '093', '123', '132', '135', '136', '137'] when associated Claim Type is CIP (Inpatient Claim)	1. Value must be 3 characters2. Mandatory3. Value must not equal '086' if Sex (ELG.002.023) equals 'M'4. Value must be in ['001', '058', '060', '084', '086', '090', '091', '092', '093', '123', '132', '135', '136', '137'] when associated Claim Type is CIP (Inpatient Claim)
06/01/2023	3.8.0	CRX.002.053	UPDATE	Coding requirement	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Conditional	Value must be in Funding Code List (VVL)2. Value must be 1 character3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional
06/01/2023	3.8.0	COT.002.062	UPDATE	Coding requirement	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Conditional	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional
06/01/2023	3.8.0	CLT.002.076	UPDATE	Coding requirement	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Conditional	Value must be in Funding Code List (VVL)2. Value must be 1 character3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional
05/31/2023	3.8.0	CLT.002.076	UPDATE	Coding requirement	Value must be in Funding Code List (VVL)2. Value must be 1 character3. Conditional	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Conditional
06/01/2023	3.8.0	CIP.002.126	UPDATE	Coding requirement	Value must be in Funding Code List (VVL)2. Value must be 1 character3. Conditional	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional
09/01/2023	3.12.0	CRX.003.129	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is "0", then the Medicare Paid Amount must not be populated.4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is "0", then the value must not be populated.4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"
08/28/2023	3.12.0	CRX.002.043	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is '0' (not a crossover claim), then value should not be populated.4. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in ["01", "02", "03", "04", "05", "06", "08", "09", or "10"], then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is '0' (not a crossover claim), then value should not be populated.4. Conditional5. When populated, value must be less than or equal to Total Billed Amount
09/01/2023	3.12.0	COT.003.182	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is "0", then the Medicare Paid Amount must not be populated.4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is "0", then the value must not be populated.4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"
08/28/2023	3.12.0	COT.002.052	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is '0' (not a crossover claim), then value should not be populated.4. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in ["01", "02", "03", "04", "05", "06", "08", "09", or "10"], then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is '0' (not a crossover claim), then value should not be populated.4. Conditional5. When populated, value must be less than or equal to Total Billed Amount
09/01/2023	3.12.0	CLT.002.179	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is "0", then the Medicare Paid Amount must not be populated.4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is "0", then the value must not be populated.4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"
08/28/2023	3.12.0	CLT.002.067	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is '0' (not a crossover claim), then value should not be populated.4. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in ["01", "02", "03", "04", "05", "06", "08", "09", or "10"], then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is '0' (not a crossover claim), then value should not be populated.4. Conditional5. When populated, value must be less than or equal to Total Billed Amount
09/01/2023	3.12.0	CIP.002.228	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is "0", then the Medicare Paid Amount must not be populated.4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Crossover Indicator value is "0", then the value must not be populated.4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"
05/31/2023	3.8.0	CLT.003.211	UPDATE	Coding requirement	1. Value must be 3 characters2. Mandatory3. Value must satisfy the requirements of Type of Service (Long Term Claim) List (VVL)	1. Value must be 3 characters2. Mandatory3. Value must be in ['009', '044', '045', '046', '047', '048', '050', '059', '133', '136', '137', '146', '147'] when associated Claim Type is CLT (Long Term Claim)
07/13/2023	3.10.0	CRX.002.022	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less5. The Prescription Fill Date (CRX.002.085) on the claim must fall between Enrollment Timespan Effective Date (ELG.021.253) and Enrollment Timespan End Date (ELG.021.253)	1. Mandatory2. Value must be 20 characters or less3. The Prescription Fill Date (CRX.002.085) on the claim must fall between Enrollment Timespan Effective Date (ELG.021.253) and Enrollment Timespan End Date (ELG.021.253)
09/21/2023	3.13.0	ELG.004.062	UPDATE	Segment key field identifier	Not Applicable	1
05/31/2023	3.8.0	COT.003.186	UPDATE	Coding requirement	1. Value must be 3 characters2. Mandatory3. When value is in [119-122], Servicing Provider NPI Num (COT.002.190) should not be populated4. Value must satisfy the requirements of Type of Service (Other Claim) List (VVL)5. When value is in [119-122], Servicing Provider Taxonomy (COT.003.191) should not be populated6. When value is in [119-122], Referring Provider NPI Num (COT.002.118) should not be populated7. Value must be 3 characters8. Mandatory9. When value is in [119-122], Billing Provider NPI Num (COT.002.113) should not be populated10. When value is in [119-122], Billing Provider Taxonomy (COT.002.114) should not be populated11. When value is in [119-122], Referring Provider Taxonomy (COT.002.119) should not be populated12. When value is not in ['025','085'], Sex (ELG.002.023) equals 'M'13. When value is in [119-122], Servicing Provider Num (COT.002.189) should not be populated	1. Value must be 3 characters2. Mandatory3. When value is in [119-122], Servicing Provider NPI Num (COT.002.190) should not be populated4. Value must be in ['002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '127', '131', '134', '135', '136', '137', '138', '139', '140', '141', '142', '143', '144', '145', '147'] when associated Claim Type is COT (Other Claim)5. When value is in [119-122], Servicing Provider Taxonomy (COT.003.191) should not be populated6. When value is in [119-122], Referring Provider NPI Num (COT.002.118) should not be populated7. Value must be 3 characters8. Mandatory9. When value is in [119-122], Billing Provider NPI Num (COT.002.113) should not be populated10. When value is in [119-122], Billing Provider Taxonomy (COT.002.114) should not be populated11. When value is in [119-122], Referring Provider Taxonomy (COT.002.119) should not be populated12. When value is not in ['025','085'], Sex (ELG.002.023) equals 'M'13. When value is in [119-122], Servicing Provider Num (COT.002.189) should not be populated
07/13/2023	3.10.0	CLT.002.022	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less5. Populated value must begin with an '&', when TYPE-OF-CLAIM = 4, D or X (lump sum payment)6. The Beginning Date of Service on the claim must fall between (ELG.021.253) enrollment effective and (ELG.021.253) end date	1. Mandatory2. Value must be 20 characters or less3. Populated value must begin with an '&', when TYPE-OF-CLAIM = 4, D or X (lump sum payment)4. The Beginning Date of Service on the claim must fall between (ELG.021.253) enrollment effective and (ELG.021.253) end date
07/13/2023	3.10.0	CIP.002.022	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less5. When Type of Claim not in (4, D, X, Z, U, V, Y, W), value must match MSIS Identification Number (ELG.021.251) and the Admission Date (CIP.002.094) must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)6. When Type of Claim (CIP.002.100) equals 4, D or X (lump sum payment) value must begin with an '&'	1. Mandatory2. Value must be 20 characters or less3. When Type of Claim not in (4, D, X, Z, U, V, Y, W), value must match MSIS Identification Number (ELG.021.251) and the Admission Date (CIP.002.094) must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)4. When Type of Claim (CIP.002.100) equals 4, D or X (lump sum payment) value must begin with an '&'
07/13/2023	3.10.0	COT.002.022	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less5. Populated value must begin with an '&', when Type of Claim (COT.002.037) = 4, D or X (lump sum payment)6. Value must match MSIS Identification Number (ELG.021.251) and the Beginning Date of Service (COT.002.033) must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)	1. Mandatory2. Value must be 20 characters or less3. Populated value must begin with an '&', when Type of Claim (COT.002.037) = 4, D or X (lump sum payment)4. Value must match MSIS Identification Number (ELG.021.251) and the Beginning Date of Service (COT.002.033) must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)
05/31/2023	3.8.0	CIP.003.257	UPDATE	Coding requirement	1. Value must be 3 characters2. Mandatory3. Value must not equal '086' if Sex (ELG.002.023) equals 'M'4. Value must satisfy the requirements of Type of Service (Inpatient Claim) List (VVL)	Value must be 3 characters2. Mandatory3. Value must not equal '086' if Sex (ELG.002.023) equals 'M'4. Value must be in ['001', '058', '060', '084', '086', '090', '091', '092', '093', '123', '132', '135', '136', '137'] when associated Claim Type is CIP (Inpatient Claim)
06/01/2023	3.8.0	CRX.003.134	UPDATE	Coding requirement	1. Value must be 3 characters2. Mandatory3. Value must satisfy the requirements of Type of Service (RX Claim) List (VVL)	1. Value must be 3 characters2. Mandatory3. Value must be in ['011', '018', '033', '034', '036', '085', '089', '127', '131', '136', '137', '145'] when associated Claim Type is CRX (RX Claim)
07/14/2023	3.10.0	ELG.003.038	UPDATE	Definition	A code indicating the family income level.	A code indicating the federal poverty level range in which the family income falls.If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.
08/09/2023	3.11.0	MCR.002.020	UPDATE	Definition	The first calendar day on which all of the other data elements in the same segment were effective.	The start date of the managed care contract period with the state.
09/21/2023	3.13.0	ELG.014.196	UPDATE	Segment key field identifier	Not Applicable	(a)
08/07/2023	3.11.0	CIP.003.239	UPDATE	Coding requirement	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim (CE) value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim (CE) value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated
08/07/2023	3.11.0	CRX.003.116	UPDATE	Coding requirement	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim (CE) value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim (CE) value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated
08/07/2023	3.11.0	CLT.003.192	UPDATE	Coding requirement	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim (CE) value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim (CE) value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated
08/07/2023	3.11.0	COT.003.162	UPDATE	Coding requirement	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim (CE) value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim (CE) value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated
04/21/2023	3.6.0	RULE-7427	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7540	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7539	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7538	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7781	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7780	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7779	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7778	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7777	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7776	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7775	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7774	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7666	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7665	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7664	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7663	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7662	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7735	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7734	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7733	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7732	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7731	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7729	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7728	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7706	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7702	ADD	N/A		Created
04/21/2023	3.6.0	RULE-7182	ADD	N/A		Created
04/21/2023	3.6.0	MCR-9-019-21	ADD	N/A		Created
04/21/2023	3.6.0	MCR-13-019-21	ADD	N/A		Created
04/21/2023	3.6.0	MCR-9-018-20	ADD	N/A		Created
04/21/2023	3.6.0	MCR-13-018-20	ADD	N/A		Created
04/21/2023	3.6.0	EL-20-001-1	ADD	N/A		Created
09/06/2023	3.12.0	EXP-39-001_1-2	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	EXP-39-001_1-2	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	EXP-39-001_1-2	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	EXP-39-001_1-2	UPDATE	Ta min		0
09/06/2023	3.12.0	EXP-39-001_1-2	UPDATE	Ta max		0.3
09/06/2023	3.12.0	EXP-39-001_1-2	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	EXP-39-001_1-2	UPDATE	Threshold maximum	TBD	0.3
09/06/2023	3.12.0	EXP-37-001_1-2	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	EXP-37-001_1-2	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	EXP-37-001_1-2	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	EXP-37-001_1-2	UPDATE	Ta min		0
09/06/2023	3.12.0	EXP-37-001_1-2	UPDATE	Ta max		0.3
09/06/2023	3.12.0	EXP-37-001_1-2	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	EXP-37-001_1-2	UPDATE	Threshold maximum	TBD	0.3
09/06/2023	3.12.0	RULE-7569	UPDATE	Measure name	% of Submitting State Provider IDs (FACILITY-GROUP-INDIVIDUAL-CODE = 03) with more than one NPI (PROV-IDENTIFIER-TYPE = 2) (across all time)	% of Provider Attributes Main segments for individual providers (FACILITY-GROUP-INDIVIDUAL-CODE = 03) with more than one NPI (PROV-IDENTIFIER-TYPE = 2) (across all time)
06/02/2023	3.8.0	MCR-64-004_1-8	UPDATE	Priority	High	Medium
06/02/2023	3.8.0	MCR-64-003_1-7	UPDATE	Priority	High	Medium
06/02/2023	3.8.0	MCR-64-002_1-6	UPDATE	Priority	High	Medium
06/02/2023	3.8.0	MCR-64-001_1-5	UPDATE	Priority	High	Medium
09/06/2023	3.12.0	EL-6-036-36	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Dual eligiblesOf the MSIS IDs which meet the criteria from STEP 2, restrict to dual eligibles:1. DUAL-ELIGIBLE-CODE equals ("01" or "02" or "03" or "04" or "05" or "06" or "08" or "09" or "10")STEP 4: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: Medicare Beneficiary Identifier is missingOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1. MEDICARE-BENEFICIARY-IDENTIFIER is missingSTEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Dual eligiblesOf the MSIS IDs which meet the criteria from STEP 2, restrict to dual eligibles:1. DUAL-ELIGIBLE-CODE equals ("01" or "02" or "03" or "04" or "05" or "06" or "08" or "09" or "10")STEP 4: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: Medicare Beneficiary Identifier is missingOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1. MEDICARE-BENEFICIARY-IDENTIFIER is missingSTEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 4
09/06/2023	3.12.0	MIS-86-020-20	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
09/06/2023	3.12.0	MIS-86-018-18	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
09/06/2023	3.12.0	MIS-86-015-15	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
09/06/2023	3.12.0	MIS-86-014-14	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
09/06/2023	3.12.0	MIS-86-003-3	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
09/06/2023	3.12.0	MIS-86-002-2	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
09/06/2023	3.12.0	MCR-59-003-15	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 3, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of header claims from STEP 7 by the count of header claims from STEP 5.	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 5, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of header claims from STEP 7 by the count of header claims from STEP 5.
09/06/2023	3.12.0	MCR-59-002-14	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 3, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of header claims from STEP 7 by the count of header claims from STEP 5.	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 5, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of header claims from STEP 7 by the count of header claims from STEP 5.
06/02/2023	3.8.0	ALL-13-003-5	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT_IND = "0"STEP 3: Non-missing beginning date of serviceOf the claims that meet the criteria from STEP 2, restrict to non-missing ADMISSION-DATESTEP 4: Link claims to enrollment time spanKeep all claims from STEP 3 for which the MSIS ID on the claim is also found on an ENROLLMENT-TIME-SPAN-ELG00021 segmentSTEP 5: Alien during date of serviceLink MSIS-IDs from the claims in STEP 4 to the ELIGIBILITY-DETERMINANTS-ELG00005 file segment and keep segments that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. RESTRICTED-BENEFIT-CODE = "2"3. Claims ADMISSION-DATE>= ELIGIBILITY-DETERMINANT-EFF-DATE4. Claims ADMISSION-DATE <= ELIGIBILITY-DETERMINANT-END-DATE OR ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 5, limit to unique MSIS-IDsSTEP 7: Non-emergency room and non-pregnancy related servicesOf the claims that meet the criteria from STEP 5, restrict to claims with that do NOT have emergency room revenue codes or pregnancy-related diagnosis codes or procedure codes:NOT (1a. REVENUE-CODE equal to ("450", "451", "452", "453", "454", "455", "456", "457", "458", "459", "0450", "0451", "0452", "0453", "0454", "0455", "0456", "0457", "0458", "0459" ,“0981”,“0720”, “0721”, “0722”, “0723”, “0724”, “0729”)OR2a. DIAGNOSIS-CODE-1 through DIAGNOSIS-CODE-12 is found in the Pregnancy CodeSet tab for ICD-10-CM code typesOR3a. PROCEDURE-CODE-1 through PROCEDURE-CODE-6 is found in the Pregnancy CodeSet tab for ICD-10-PCM code types)STEP 8: Calculate percentageDivide the count of unique MSIS-IDs from STEP 7 by the count of MSIS-IDs from STEP 6	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS and Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "3"2. ADJUSTMENT_IND = "0"STEP 3: Non-missing admission dateOf the claims that meet the criteria from STEP 2, restrict to non-missing ADMISSION-DATESTEP 4: Link claims to enrollment time spanKeep all claims from STEP 3 for which the MSIS ID on the claim is also found on an ENROLLMENT-TIME-SPAN-ELG00021 segmentSTEP 5: Alien during date of serviceLink MSIS-IDs from the claims in STEP 4 to the ELIGIBILITY-DETERMINANTS-ELG00005 file segment and keep segments that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. RESTRICTED-BENEFIT-CODE = "2"3. Claims ADMISSION-DATE>= ELIGIBILITY-DETERMINANT-EFF-DATE4. Claims ADMISSION-DATE <= ELIGIBILITY-DETERMINANT-END-DATE OR ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 5, limit to unique MSIS-IDsSTEP 7: Non-emergency room and non-pregnancy related servicesOf the claims that meet the criteria from STEP 5, restrict to claims with that do NOT have emergency room revenue codes or pregnancy-related diagnosis codes or procedure codes:NOT (1a. REVENUE-CODE equal to ("450", "451", "452", "453", "454", "455", "456", "457", "458", "459", "0450", "0451", "0452", "0453", "0454", "0455", "0456", "0457", "0458", "0459" ,“0981”,“0720”, “0721”, “0722”, “0723”, “0724”, “0729”)OR2a. DIAGNOSIS-CODE-1 through DIAGNOSIS-CODE-12 is found in the Pregnancy CodeSet tab for ICD-10-CM code typesOR3a. PROCEDURE-CODE-1 through PROCEDURE-CODE-6 is found in the Pregnancy CodeSet tab for ICD-10-PCM code types)STEP 8: Calculate percentageDivide the count of unique MSIS-IDs from STEP 7 by the count of MSIS-IDs from STEP 6
06/02/2023	3.8.0	Data Quality Measures	UPDATE	Version text	3.7.0	3.8.0
09/21/2023	3.13.0	MCR.003.037	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	PRV.006.087	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	PRV.006.085	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	MCR.003.035	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	PRV.005.075	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	PRV.005.073	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	PRV.004.063	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	PRV.004.061	UPDATE	Segment key field identifier	Not Applicable	1
07/13/2023	3.10.0	TPL.005.066	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
09/21/2023	3.13.0	TPL.005.064	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	TPL.004.055	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	TPL.004.053	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	PRV.003.042	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	PRV.003.040	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	MCR.007.085	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	MCR.007.083	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	PRV.010.128	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	PRV.010.126	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	MCR.006.076	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	MCR.006.074	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	PRV.009.118	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	PRV.009.116	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	PRV.008.109	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	PRV.008.107	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	MCR.004.057	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	MCR.004.055	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	PRV.007.097	UPDATE	Segment key field identifier	Not Applicable	2
09/21/2023	3.13.0	PRV.007.095	UPDATE	Segment key field identifier	Not Applicable	1
08/10/2023	3.11.0	CRX - CLAIM PHARMACY	UPDATE	Title	CRX - CLAIM PRESCRIPTION	CRX - CLAIM PHARMACY
04/21/2023	3.6.0	Data Quality Measures	UPDATE	Version text	3.6.0	3.7.0
04/21/2023	3.6.0	EXP-39-001_1-2	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims from STEP 3, select records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Medicaid paid $0 or missingOf the claims from STEP 3, select records where:1. MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate the percentage for the measureDivide the count of claim lines from STEP 4 by the count of claims lines from STEP 3	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Payment at the line levelOf the claims from STEP 3, select records where:1. PAYMENT-LEVEL-IND = "2"STEP 5: Medicaid paid $0 or missingOf the claims from STEP 4, select records where:1. MEDICAID-PAID-AMT = "0" or is missingSTEP 6: Calculate the percentage for the measureDivide the count of claim lines from STEP 5 by the count of claims lines from STEP 4.
03/10/2023	3.4.0	EXP-39-001_1-2	ADD	N/A		Created
04/21/2023	3.6.0	EXP-37-001_1-2	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Payment at the line levelOf the claims from STEP 3, select records where:1. PAYMENT-LEVEL-IND = "2"STEP 4: Medicaid paid $0 or missingOf the claims from STEP 3, select records where:1. MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate the percentage for the measureDivide the count of claim lines from STEP 4 by the count of claims lines from STEP 3	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Payment at the line levelOf the claims from STEP 3, select records where:1. PAYMENT-LEVEL-IND = "2"STEP 5: Medicaid paid $0 or missingOf the claims from STEP 4, select records where:1. MEDICAID-PAID-AMT = "0" or is missingSTEP 6: Calculate the percentage for the measureDivide the count of claim lines from STEP 5 by the count of claims lines from STEP 4.
03/10/2023	3.4.0	EXP-37-001_1-2	ADD	N/A		Created
09/06/2023	3.12.0	EXP-11-161_1-164	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	EXP-11-161_1-164	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	EXP-11-161_1-164	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	EXP-11-161_1-164	UPDATE	Ta min		0
09/06/2023	3.12.0	EXP-11-161_1-164	UPDATE	Ta max		0.3
09/06/2023	3.12.0	EXP-11-161_1-164	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	EXP-11-161_1-164	UPDATE	Threshold maximum	TBD	0.3
03/10/2023	3.4.0	EXP-11-161_1-164	ADD	N/A		Created
09/06/2023	3.12.0	EXP-11-160_1-163	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	EXP-11-160_1-163	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	EXP-11-160_1-163	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	EXP-11-160_1-163	UPDATE	Ta min		0
09/06/2023	3.12.0	EXP-11-160_1-163	UPDATE	Ta max		0.15
09/06/2023	3.12.0	EXP-11-160_1-163	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	EXP-11-160_1-163	UPDATE	Threshold maximum	TBD	0.15
03/10/2023	3.4.0	EXP-11-160_1-163	ADD	N/A		Created
09/06/2023	3.12.0	MIS-1-013-13	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	MIS-1-013-13	UPDATE	Category	N/A	Beneficiary demographics
09/06/2023	3.12.0	MIS-1-013-13	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	MIS-1-013-13	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	MIS-1-013-13	UPDATE	Ta min		0
09/06/2023	3.12.0	MIS-1-013-13	UPDATE	Ta max		0.5
09/06/2023	3.12.0	MIS-1-013-13	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	MIS-1-013-13	UPDATE	Threshold maximum	TBD	0.5
03/10/2023	3.4.0	MIS-1-013-13	ADD	N/A		Created
09/06/2023	3.12.0	EL-6-037-37	UPDATE	Priority	N/A	Medium
09/06/2023	3.12.0	EL-6-037-37	UPDATE	Category	N/A	Beneficiary demographics
09/06/2023	3.12.0	EL-6-037-37	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	EL-6-037-37	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	EL-6-037-37	UPDATE	Ta min		0
09/06/2023	3.12.0	EL-6-037-37	UPDATE	Ta max		0.1
09/06/2023	3.12.0	EL-6-037-37	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	EL-6-037-37	UPDATE	Threshold maximum	TBD	0.1
03/10/2023	3.4.0	EL-6-037-37	ADD	N/A		Created
09/06/2023	3.12.0	EL-1-040-47	UPDATE	Threshold minimum	TBD	N/A
09/06/2023	3.12.0	EL-1-040-47	UPDATE	Threshold maximum	TBD	N/A
03/10/2023	3.4.0	EL-1-040-47	ADD	N/A		Created
09/06/2023	3.12.0	EL-1-039-46	UPDATE	Threshold minimum	TBD	N/A
09/06/2023	3.12.0	EL-1-039-46	UPDATE	Threshold maximum	TBD	N/A
03/10/2023	3.4.0	EL-1-039-46	ADD	N/A		Created
09/06/2023	3.12.0	EL-1-038-45	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	EL-1-038-45	UPDATE	Category	N/A	Beneficiary demographics
09/06/2023	3.12.0	EL-1-038-45	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	EL-1-038-45	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	EL-1-038-45	UPDATE	Ta min		0
09/06/2023	3.12.0	EL-1-038-45	UPDATE	Ta max		0.99
09/06/2023	3.12.0	EL-1-038-45	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	EL-1-038-45	UPDATE	Threshold maximum	TBD	0.99
03/10/2023	3.4.0	EL-1-038-45	ADD	N/A		Created
04/21/2023	3.6.0	EL-6-036-36	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Dual eligiblesOf the MSIS IDs which meet the criteria from STEP 2, restrict to dual eligibles:1. DUAL-ELIGIBLE-CODE equals ("01" or "02" or "03" or "04" or "05" or "06" or "08" or "09" or "10")STEP 4: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 34, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: Medicare Beneficiary Identifier is missingOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1. MEDICARE-BENEFICIARY-IDENTIFIER is missingSTEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Dual eligiblesOf the MSIS IDs which meet the criteria from STEP 2, restrict to dual eligibles:1. DUAL-ELIGIBLE-CODE equals ("01" or "02" or "03" or "04" or "05" or "06" or "08" or "09" or "10")STEP 4: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: Medicare Beneficiary Identifier is missingOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1. MEDICARE-BENEFICIARY-IDENTIFIER is missingSTEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3
04/21/2023	3.6.0	MIS-28-003-3	UPDATE	Priority	Medium	N/A
04/21/2023	3.6.0	MIS-26-005-5	UPDATE	Priority	Medium	N/A
04/21/2023	3.6.0	MIS-24-012-12	UPDATE	Priority	Medium	N/A
04/21/2023	3.6.0	MIS-22-012-12	UPDATE	Priority	Medium	N/A
04/21/2023	3.6.0	EL-3-025-30	UPDATE	Annotation	N/A	Count the number of mandatory eligibility groups for SSI or ABD individuals with at least one MSIS ID with a primary eligibility group indicator associated with it
04/21/2023	3.6.0	EL-3-025-30	UPDATE	Specification	N/A	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Frequency of mandatory eligibility groupsOf the MSIS IDs that meet the criteria from STEP 2, count the number of unique MSIS IDs where ELIGIBILITY-GROUP is equal to each of the following values: 11, 12STEP 4: Count of categoriesOf the 2 mandatory eligibility group categories referenced in STEP 3, count the number of categories with at least one MSIS ID
09/21/2023	3.13.0	ELG.003.031	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	ELG.012.169	UPDATE	Segment key field identifier	Not Applicable	1
07/13/2023	3.10.0	ELG.011.162	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
09/21/2023	3.13.0	ELG.011.160	UPDATE	Segment key field identifier	Not Applicable	1
07/13/2023	3.10.0	ELG.010.149	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
09/21/2023	3.13.0	ELG.010.147	UPDATE	Segment key field identifier	Not Applicable	1
07/14/2023	3.10.0	ELG.009.139	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
09/21/2023	3.13.0	CLT.003.213	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Claim (CLT.002.052) not in ('3','C','W') then value must match Provider Identifier (PRV.005.081)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Claim (CLT.002.052) not in ('3','C','W') then value must match Provider Identifier (PRV.005.081)5. Value must exist in the NPPES NPI data file
09/21/2023	3.13.0	ELG.009.137	UPDATE	Segment key field identifier	Not Applicable	1
07/13/2023	3.10.0	ELG.008.129	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
09/21/2023	3.13.0	ELG.008.127	UPDATE	Segment key field identifier	Not Applicable	1
07/13/2023	3.10.0	ELG.007.117	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
09/21/2023	3.13.0	ELG.007.115	UPDATE	Segment key field identifier	Not Applicable	1
07/13/2023	3.10.0	ELG.021.251	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
09/21/2023	3.13.0	ELG.021.249	UPDATE	Segment key field identifier	Not Applicable	1
07/13/2023	3.10.0	ELG.006.106	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
09/21/2023	3.13.0	ELG.006.104	UPDATE	Segment key field identifier	Not Applicable	1
07/13/2023	3.10.0	ELG.020.241	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
09/21/2023	3.13.0	ELG.020.239	UPDATE	Segment key field identifier	Not Applicable	1
07/13/2023	3.10.0	TPL.002.019	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
09/21/2023	3.13.0	TPL.002.017	UPDATE	Segment key field identifier	Not Applicable	1
07/13/2023	3.10.0	ELG.018.232	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
09/21/2023	3.13.0	ELG.018.230	UPDATE	Segment key field identifier	Not Applicable	1
07/13/2023	3.10.0	ELG.017.223	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
07/13/2023	3.10.0	ELG.005.082	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
09/21/2023	3.13.0	ELG.017.221	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	ELG.005.080	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	COT.003.189	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ("Z","3","C",'W',"2","B","V","4","D","X") then value may match (PRV.005.081) Provider Identifier or4. When Type of Claim not in ("Z","3","C",'W',"2","B","V","4","D","X") then value may match (PRV.002.019) Submitting State Provider ID5. When Type of Claim in ["1","3","A","C"] then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in "01", "02", "03", "04", "05", "06"] (active)
07/13/2023	3.10.0	ELG.016.212	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
07/13/2023	3.10.0	ELG.012.171	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
09/21/2023	3.13.0	COT.003.190	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Claim (COT.002.037) not in ('3','C','W') then value must match Provider Identifier (PRV.005.081)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Claim (COT.002.037) not in ('3','C','W') then value must match Provider Identifier (PRV.005.081)5. Value must exist in the NPPES NPI data file
09/21/2023	3.13.0	ELG.016.210	UPDATE	Segment key field identifier	Not Applicable	1
08/28/2023	3.12.0	CRX.002.102	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. When Type of Claim not in ('3','C','W') then value must match Provider Identifier (PRV.005.081)4. Mandatory	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2'3. When Type of Claim not in ('3','C','W') then value must match Provider Identifier (PRV.005.081)4. Mandatory5. Value must exist in the NPPES NPI data file6. Nppes Entity Type Code associate with this NPI must equal ‘1’ (Individual)
07/13/2023	3.10.0	ELG.004.064	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
07/13/2023	3.10.0	ELG.015.203	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
09/21/2023	3.13.0	ELG.015.201	UPDATE	Segment key field identifier	Not Applicable	1
08/15/2023	3.12.0	COT.003.168	UPDATE	Coding requirement	1. Value must be in Revenue Code List (VVL)2. A Revenue Code (CE) value requires an associated Revenue Charge (CE)3. Value must be 4 characters or less4. Conditional	1. Value must be in Revenue Code List (VVL)2. A Revenue Code value requires an associated Revenue Charge3. Value must be 4 characters or less4. Conditional
07/13/2023	3.10.0	ELG.014.191	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
03/24/2023	3.5.0	COT.003.169	UPDATE	Medicaid valid value info	HCPCS Code ListDental Codes ListProcedure Codes	HCPCS Code ListDental Code ListCPT Code List
09/21/2023	3.13.0	ELG.014.189	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	CIP.003.261	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. Value must exist in the NPPES NPI data file5. When Type of Claim is in ['1','3','A','C'], then value must be populated
07/13/2023	3.10.0	ELG.013.181	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
09/21/2023	3.13.0	ELG.013.179	UPDATE	Segment key field identifier	Not Applicable	1
07/13/2023	3.10.0	ELG.003.033	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN3. Value must be 20 characters or less
02/23/2023	3.4.0	CIP.002.099	UPDATE	Definition	The date Medicaid paid this claim or adjustment.	The date Medicaid paid this claim or adjustment. For Encounter Records (Type of Claim = 3, C, W), the date the managed care organization paid the provider for the claim or adjustment.
03/10/2023	3.4.0	Data Quality Measures	UPDATE	Version text	3.5.0	3.6.0
08/28/2023	3.12.0	CRX.003.172	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1]	1. Value must be 1 character2. Value must be in [0, 1]3. Mandatory
08/28/2023	3.12.0	COT.003.234	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1]	1. Value must be 1 character2. Value must be in [0, 1]3. Mandatory
08/28/2023	3.12.0	CLT.003.243	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1]	1. Value must be 1 character2. Value must be in [0, 1]3. Mandatory
08/28/2023	3.12.0	CIP.003.296	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1]	1. Value must be 1 character2. Value must be in [0, 1]3. Mandatory
02/16/2023	3.3.0	CRX.003.172	UPDATE	Definition	This data element indicates services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes.	To indicate Services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes.
02/16/2023	3.3.0	COT.003.234	UPDATE	Definition	This data element indicates services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes.	To indicate Services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes.
02/16/2023	3.3.0	CLT.003.243	UPDATE	Definition	This data element indicates services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes.	To indicate Services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes.
02/16/2023	3.3.0	CIP.003.296	UPDATE	Definition	This data element indicates services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes.	To indicate Services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes.
02/17/2023	3.3.0	Data Quality Measures	UPDATE	Version text	3.4.0	3.5.0
01/27/2023	3.2.0	RULE-7239	ADD	N/A		Created
01/27/2023	3.2.0	RULE-7220	ADD	N/A		Created
01/27/2023	3.2.0	RULE-7569	ADD	N/A		Created
01/27/2023	3.2.0	RULE-7446	ADD	N/A		Created
01/27/2023	3.2.0	RULE-7445	ADD	N/A		Created
01/27/2023	3.2.0	RULE-7444	ADD	N/A		Created
01/27/2023	3.2.0	RULE-7443	ADD	N/A		Created
01/27/2023	3.2.0	RULE-7442	ADD	N/A		Created
09/06/2023	3.12.0	RULE-7441	UPDATE	Measure name	% claim headers with a BILLING-PROV-NUM that does not have a match in PRV00007 with active provider enrollment status (PROV-MEDICAID-ENROLLMENT-STATUS-CODE in (1, 2, 3, 4, 5, 6) on Beginning Date of Service	% of claim headers with a BILLING-PROV-NUM that does not have a match in PRV00007 with active provider enrollment status (PROV-MEDICAID-ENROLLMENT-STATUS-CODE in (1, 2, 3, 4, 5, 6) on Beginning Date of Service
01/27/2023	3.2.0	RULE-7441	ADD	N/A		Created
01/27/2023	3.2.0	RULE-7440	ADD	N/A		Created
03/10/2023	3.4.0	RULE-7439	UPDATE	Measure name	% claim headers with a BILLING-PROV-NUM that does not have a match in PRV00007 with active provider enrollment status (PROV-MEDICAID-ENROLLMENT-STATUS-CODE in (1, 2, 3, 4, 5, 6) on Admission Date	% of claim headers with a BILLING-PROV-NUM that does not have a match in PRV00007 with active provider enrollment status (PROV-MEDICAID-ENROLLMENT-STATUS-CODE in (1, 2, 3, 4, 5, 6) on Admission Date
01/27/2023	3.2.0	RULE-7439	ADD	N/A		Created
03/10/2023	3.4.0	RULE-7460	UPDATE	Measure name	% of claim lines with HCBS-SERVICE-CODE = 4 that are missing Waiver ID	% of claim headers with HCBS-SERVICE-CODE = 4 that are missing Waiver ID
01/27/2023	3.2.0	RULE-7460	ADD	N/A		Created
01/27/2023	3.2.0	RULE-7459	ADD	N/A		Created
01/27/2023	3.2.0	RULE-7458	ADD	N/A		Created
09/06/2023	3.12.0	EL-1-037-44	UPDATE	Threshold minimum	TBD	N/A
09/06/2023	3.12.0	EL-1-037-44	UPDATE	Threshold maximum	TBD	N/A
09/06/2023	3.12.0	EL-1-037-44	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is OtherOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE equals “018”on any record segment Step 4 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 3, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 5: Calculate percentage Divide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is OtherOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE equals “018”on any record segmentSTEP 4: Ethnicity information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ETHNICITY-INFORMATION-ELG00015 by keeping active records that satisfy the following criteria:1a. ETHNICITY-DECLARATION-EFF-DATE <= last day of the DQ report month2a. ETHNICITY-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. ETHNICITY-DECLARATION-EFF-DATE is missing2b. ETHNICITY-DECLARATION-END-DATE is missingSTEP 5 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 6: Calculate percentage Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3
01/27/2023	3.2.0	EL-1-037-44	ADD	N/A		Created
09/06/2023	3.12.0	EL-1-036-43	UPDATE	Threshold minimum	TBD	N/A
09/06/2023	3.12.0	EL-1-036-43	UPDATE	Threshold maximum	TBD	N/A
09/06/2023	3.12.0	EL-1-036-43	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is Native Hawaiian or Other Pacific IslanderOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE = “012,” "013," "014," "015," or "016" on any record segment Step 4 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 3, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 5: Calculate percentage Divide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is Native Hawaiian or Other Pacific IslanderOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE = “012,” "013," "014," "015," or "016" on any record segmentSTEP 4: Ethnicity information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ETHNICITY-INFORMATION-ELG00015 by keeping active records that satisfy the following criteria:1a. ETHNICITY-DECLARATION-EFF-DATE <= last day of the DQ report month2a. ETHNICITY-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. ETHNICITY-DECLARATION-EFF-DATE is missing2b. ETHNICITY-DECLARATION-END-DATE is missingSTEP 5 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 6: Calculate percentage Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3
01/27/2023	3.2.0	EL-1-036-43	ADD	N/A		Created
09/06/2023	3.12.0	EL-1-035-42	UPDATE	Threshold minimum	TBD	N/A
09/06/2023	3.12.0	EL-1-035-42	UPDATE	Threshold maximum	TBD	N/A
09/06/2023	3.12.0	EL-1-035-42	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is AsianOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE = “004,” "005," "006," "007," "008," "009," "010," or "011" on any record segment Step 4 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 3, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 4: Calculate percentage Divide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is AsianOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE = “004,” "005," "006," "007," "008," "009," "010," or "011" on any record segmentSTEP 4: Ethnicity information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ETHNICITY-INFORMATION-ELG00015 by keeping active records that satisfy the following criteria:1a. ETHNICITY-DECLARATION-EFF-DATE <= last day of the DQ report month2a. ETHNICITY-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. ETHNICITY-DECLARATION-EFF-DATE is missing2b. ETHNICITY-DECLARATION-END-DATE is missingSTEP 5 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 6: Calculate percentage Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3
01/27/2023	3.2.0	EL-1-035-42	ADD	N/A		Created
09/06/2023	3.12.0	EL-1-034-41	UPDATE	Threshold minimum	TBD	N/A
09/06/2023	3.12.0	EL-1-034-41	UPDATE	Threshold maximum	TBD	N/A
09/06/2023	3.12.0	EL-1-034-41	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is American Indian or Alaska NativeOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE equals “003”on any record segment Step 4 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 3, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 5: Calculate percentage Divide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is American Indian or Alaska NativeOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE equals “003”on any record segmentSTEP 4: Ethnicity information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ETHNICITY-INFORMATION-ELG00015 by keeping active records that satisfy the following criteria:1a. ETHNICITY-DECLARATION-EFF-DATE <= last day of the DQ report month2a. ETHNICITY-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. ETHNICITY-DECLARATION-EFF-DATE is missing2b. ETHNICITY-DECLARATION-END-DATE is missingSTEP 5 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 6: Calculate percentage Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3
01/27/2023	3.2.0	EL-1-034-41	ADD	N/A		Created
09/06/2023	3.12.0	EL-1-033-40	UPDATE	Threshold minimum	TBD	N/A
09/06/2023	3.12.0	EL-1-033-40	UPDATE	Threshold maximum	TBD	N/A
09/06/2023	3.12.0	EL-1-033-40	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is Black or African AmericanOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE equals “002”on any record segment Step 4 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 3, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 5: Calculate percentage Divide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is Black or African AmericanOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE equals “002”on any record segmentSTEP 4: Ethnicity information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ETHNICITY-INFORMATION-ELG00015 by keeping active records that satisfy the following criteria:1a. ETHNICITY-DECLARATION-EFF-DATE <= last day of the DQ report month2a. ETHNICITY-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. ETHNICITY-DECLARATION-EFF-DATE is missing2b. ETHNICITY-DECLARATION-END-DATE is missingSTEP 5 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 6: Calculate percentage Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3
01/27/2023	3.2.0	EL-1-033-40	ADD	N/A		Created
09/06/2023	3.12.0	EL-1-032-39	UPDATE	Threshold minimum	TBD	N/A
09/06/2023	3.12.0	EL-1-032-39	UPDATE	Threshold maximum	TBD	N/A
09/06/2023	3.12.0	EL-1-032-39	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is WhiteOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE equals “001”on any record segment Step 4 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 3, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 5: Calculate percentage Divide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION ELG00016 by keeping records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is WhiteOf the MSIS IDs that meet the criteria from STEP 2, further restrict the population by keeping MSIS IDs where:1. RACE equals “001”on any record segmentSTEP 4: Ethnicity information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ETHNICITY-INFORMATION-ELG00015 by keeping active records that satisfy the following criteria:1a. ETHNICITY-DECLARATION-EFF-DATE <= last day of the DQ report month2a. ETHNICITY-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. ETHNICITY-DECLARATION-EFF-DATE is missing2b. ETHNICITY-DECLARATION-END-DATE is missingSTEP 5 : MSIS IDs where ethnicity is missing, unspecified, or invalidOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1a. ETHNICITY-CODE is not “0,” “1,” “2,” “3,” “4,” or “5”OR1b. ETHNICITY-CODE is missingSTEP 6: Calculate percentage Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3
01/27/2023	3.2.0	EL-1-032-39	ADD	N/A		Created
09/06/2023	3.12.0	PRV-2-011-11	UPDATE	Measure name	% of non-atypical providers that do not have an NPI	% of providers that require NPI (non-atypical) that are missing NPI (PROV-IDENTIFIER-TYPE=2)
09/06/2023	3.12.0	PRV-2-011-11	UPDATE	Priority	N/A	Medium
09/06/2023	3.12.0	PRV-2-011-11	UPDATE	Category	N/A	Provider classification
09/06/2023	3.12.0	PRV-2-011-11	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	PRV-2-011-11	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	PRV-2-011-11	UPDATE	Ta min		0
09/06/2023	3.12.0	PRV-2-011-11	UPDATE	Ta max		0.1
09/06/2023	3.12.0	PRV-2-011-11	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	PRV-2-011-11	UPDATE	Threshold maximum	TBD	0.1
09/06/2023	3.12.0	PRV-2-011-11	UPDATE	Annotation	Calculate the percent of providers that are not atypical and missing NPI	Calculate the percent of providers that require NPI (are not atypical) and are missing NPI
01/27/2023	3.2.0	PRV-2-011-11	ADD	N/A		Created
03/10/2023	3.4.0	EL-6-032-35	UPDATE	Priority	High	Medium
06/02/2023	3.8.0	PRV-6-004-4	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is an individualOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "03"STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Code is missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population using segment by keeping records that meet the following criteria:1. PROVIDER-CLASSIFICATION-CODE is missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is an individualOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "03"STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Code is missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population using segment by keeping records that meet the following criteria:1. PROVIDER-CLASSIFICATION-CODE is always missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3
06/02/2023	3.8.0	PRV-6-003-3	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month or missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is a facility or groupOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "01" or "02"STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Code is missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1. PROVIDER-CLASSIFICATION-CODE is missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month or missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is a facility or groupOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "01" or "02"STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Code is missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1. PROVIDER-CLASSIFICATION-CODE is always missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3
06/02/2023	3.8.0	PRV-6-002-2	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month or missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is an individualOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "03" STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Lookup Designation is "Facility or Group" or missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1a. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Provider Classification lookup tableAND1b. Provider Classification Lookup Designation = “Facility” or "Group"OR2. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE do not equal to values in Provider Classification lookup tableOR3. PROV-IDENTIFIER-TYPE is missingOR4. PROVIDER-CLASSIFICATION-CODE is missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month or missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is an individualOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "03" STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Lookup Designation is "Facility or Group" or missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1a. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Provider Classification lookup tableAND1b. Provider Classification Lookup Designation is never “Individual"OR2. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE are never equal to values in Provider Classification lookup tableOR3. PROV-IDENTIFIER-TYPE is always missingOR4. PROVIDER-CLASSIFICATION-CODE is always missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3
06/02/2023	3.8.0	PRV-6-001-1	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month or missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is a facility or groupOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "01" or "02" STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Lookup Designation is "Individual" or missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1a. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Provider Classification lookup tableAND1b. Provider Classification Lookup Designation = “Individual”OR2. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE do not equal to values in Provider Classification lookup tableOR3. PROV-IDENTIFIER-TYPE is missingOR4. PROVIDER-CLASSIFICATION-CODE is missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month or missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is a facility or groupOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "01" or "02" STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Lookup Designation is "Individual" or missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1a. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Provider Classification lookup tableAND1b. Provider Classification Lookup Designation is never “Non-Individual”OR2. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE are never equal to values in Provider Classification lookup tableOR3. PROV-IDENTIFIER-TYPE is always missingOR4. PROVIDER-CLASSIFICATION-CODE is always missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3
04/21/2023	3.6.0	PRV-2-010-10	UPDATE	Annotation	Calculate the percent of submitting-state-provider-IDs that are individual providers but have more than one reported NPI	Calculate the percent of submitting state provider IDs that are individual providers but have more than one reported NPI
02/14/2023	3.3.0	Data Quality Measures	UPDATE	Threshold and measures combined	None	225
09/21/2023	3.13.0	ELG.010.155	UPDATE	Segment key field identifier	Not Applicable	(a)
08/14/2023	3.12.0	CIP.002.096	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be less than or equal to associated Adjudication Date (CE) value.4. Value must be greater than or equal to associated Admission Date (CE) value.5. Value must be greater than or equal to associated eligible Date of Birth (CE) value.6. Value must be less than or equal to associated eligible Date of Death (CE) value.7. Conditional8. If associated Adjustment Indicator (CIP.002.026) does not equal "1" (Non-denied claims) and Patient Status (CIP.002.199) is not equal to "30" value must be populated.9. When populated, Discharge Hour (CIP.002.097) must be populated	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be less than or equal to associated Adjudication Date value.4. Value must be greater than or equal to associated Admission Date value.5. Value must be greater than or equal to associated eligible Date of Birth value.6. Value must be less than or equal to associated eligible Date of Death value.7. Conditional8. If associated Adjustment Indicator (CIP.002.026) does not equal "1" (Non-denied claims) and Patient Status (CIP.002.199) is not equal to "30" value must be populated.9. When populated, Discharge Hour (CIP.002.097) must be populated
08/09/2023	3.11.0	CRX.002.041	UPDATE	Definition	The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.	The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider.
08/14/2023	3.12.0	ELG.001.010	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. Value of the CC component must be "20"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created (CE)5. Value must be equal to or after associated Start of Time Period (CE)6. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. Value of the CC component must be "20"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created5. Value must be equal to or after associated Start of Time Period6. Mandatory
08/09/2023	3.11.0	CRX.002.039	UPDATE	Definition	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/09/2023	3.11.0	CLT.002.065	UPDATE	Definition	The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.	The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/09/2023	3.11.0	CLT.002.064	UPDATE	Definition	The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization.	The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity allowed for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/09/2023	3.11.0	CLT.002.063	UPDATE	Definition	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/12/2023	3.10.0	ELG.005.097	UPDATE	Coding requirement	1. Value must be in Restricted Benefits Code List (VVL)2. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "05", then Eligibility Group (ELG.005.087) must be "24"3. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "06", then Eligibility Group (ELG.005.087) must be "26"4. (Restricted Benefits) if value is "1" and Dual Eligible Code (ELG.005.085) value is "02", then Eligibility Group (ELG.005.087) must be "23"5. (Restricted Benefits) if value is "1" and Dual Eligible Code (ELG.005.085) value is "04", then Eligibility Group (ELG.005.087) must be "25"6. (Restricted Benefits) if value is "3", then Dual Eligible Code (ELG.005.085) cannot be "00"7. Mandatory8. If value is populated, then Eligibility Group (ELG.005.087) must be populated.9. If value is "6" then Eligibility Group(ELG.DE.087) must be in ("35", "70")10. If value is "1" or "7" then Eligibility Group (EGL.DE.087) must be in ("72", "73", "74", "75") and State Plan Option Type (ELG.DE.163) must equal to "06"11. (Restricted Pregnancy-Related) if value is "4", then associated Sex (ELG.002.023) value must be "F"12. (Non-Citizen) if value is "2", then associated Citizenship Indicator (ELG.003.040) value must not be equal to "1"13. If value is "D", there must be a corresponding MFP enrollment segment (ELG00010) with Effective and End dates that are within the timespan of this segment14. Value must be 1 character15. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "01", then Eligibility Group (ELG.005.087) must be "23"16. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "03", then Eligibility Group (ELG.005.087) must be "25"	Value must be in Restricted Benefits Code List (VVL)2. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "05", then Eligibility Group (ELG.005.087) must be "24"3. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "06", then Eligibility Group (ELG.005.087) must be "26"4. (Restricted Benefits) if value is "1" and Dual Eligible Code (ELG.005.085) value is "02", then Eligibility Group (ELG.005.087) must be "23"5. (Restricted Benefits) if value is "1" and Dual Eligible Code (ELG.005.085) value is "04", then Eligibility Group (ELG.005.087) must be "25"6. (Restricted Benefits) if value is "3", then Dual Eligible Code (ELG.005.085) cannot be "00"7. Mandatory8. If value is populated, then Eligibility Group (ELG.005.087) must be populated.9. If value is "6" then Eligibility Group(ELG.DE.087) must be in ("35", "70")10. If value is "1" or "7" then Eligibility Group (EGL.DE.087) must be in ("72", "73", "74", "75") and State Plan Option Type (ELG.DE.163) must equal to "06"11. (Restricted Pregnancy-Related) if value is "4", then associated Sex (ELG.002.023) value must be "F"12. (Non-Citizen) if value is "2", then associated Citizenship Indicator (ELG.003.040) value must not be equal to "1"13. If value is "D", there must be a corresponding MFP enrollment segment (ELG00010) with Effective and End dates that are within the timespan of this segment14. Value must be 1 character15. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "01", then Eligibility Group (ELG.005.087) must be "23"16. (Restricted Benefits) if value is "3" and Dual Eligible Code (ELG.005.085) value is "03", then Eligibility Group (ELG.005.087) must be "25"17. (Restricted Benefits) if value is "G", then Dual Eligible Code (ELG.005.085) must be in (‘01’, ‘03', ‘06’)
08/01/2023	3.11.0	ELG.005.086	UPDATE	Coding requirement	1. Value must be in Primary Eligibility Group Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. Value must be 1 character5. Mandatory	1. Value must be in Primary Eligibility Group Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1]4. Mandatory
08/09/2023	3.11.0	COT.002.050	UPDATE	Definition	The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.	The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.For sub-capitation payments, this represents the amount paid by the managed care plan to the sub-capitated entity.
08/09/2023	3.11.0	COT.002.049	UPDATE	Definition	The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization.	The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity allowed for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/09/2023	3.11.0	COT.002.048	UPDATE	Definition	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/09/2023	3.11.0	COT.002.034	UPDATE	Definition	For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, the date on which the service covered by this claim ended. For capitation premium payments, the date on which the period of coverage related to this payment ends/ended. For financial transactions reported to the OT file, populate with the last day of the time period covered by this financial transaction.	For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, the date on which the service covered by this claim ended. For capitation premium payments, the date on which the period of coverage related to this payment ends/ended. For financial transactions reported to the OT file, populate with the last day of the time period covered by this financial transaction.For sub-capitation payments, this represents the last date of the period the sub-capitation payment covers.
08/09/2023	3.11.0	COT.002.033	UPDATE	Definition	For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, this would be the date on which the service covered by this claim began. For capitation premium payments, the date on which the period of coverage related to this payment began. For financial transactions reported to the OT file, populate with the first day of the time period covered by this financial transaction.	For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, this would be the date on which the service covered by this claim began. For capitation premium payments, the date on which the period of coverage related to this payment began. For financial transactions reported to the OT file, populate with the first day of the time period covered by this financial transaction.For sub-capitation payments, this represents the first date of the period the sub-capitation payment covers.
08/09/2023	3.11.0	COT.003.167	UPDATE	Definition	For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, the date on which the service covered by this claim ended. For capitation premium payments, the date on which the period of coverage related to this payment ends/ended. For financial transactions reported to the OT file, populate with the last day of the time period covered by this financial transaction.	For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, the date on which the service covered by this claim ended. For capitation premium payments, the date on which the period of coverage related to this payment ends/ended. For financial transactions reported to the OT file, populate with the last day of the time period covered by this financial transaction.For sub-capitation payments, this represents the last date of the period the sub-capitation payment covers.
08/09/2023	3.11.0	COT.003.166	UPDATE	Definition	For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, this would be the date on which the service covered by this claim began. For capitation premium payments, the date on which the period of coverage related to this payment began. For financial transactions reported to the OT file, populate with the first day of the time period covered by this financial transaction.	For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, this would be the date on which the service covered by this claim began. For capitation premium payments, the date on which the period of coverage related to this payment began. For financial transactions reported to the OT file, populate with the first day of the time period covered by this financial transaction.For sub-capitation payments, this represents the first date of the period the sub-capitation payment covers.
08/09/2023	3.11.0	CIP.002.114	UPDATE	Definition	The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.	The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/09/2023	3.11.0	CIP.002.113	UPDATE	Definition	The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization.	The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity allowed for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/09/2023	3.11.0	CIP.002.112	UPDATE	Definition	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider.
09/21/2023	3.13.0	PRV.006.088	UPDATE	Segment key field identifier	Not Applicable	3
08/09/2023	3.11.0	ELG.005.095	UPDATE	Definition	The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed. If for a single termination in eligibility for a single individual, there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another.	The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another. Do not populate if at the time someone loses Medicaid eligibility they become eligible for and enrolled in CHIP. Also do not populate if at the time someone loses CHIP eligibility they become eligible for and enrolled in Medicaid.\|
02/23/2023	3.4.0	CIP.002.099	UPDATE	Definition	The date Medicaid paid this claim or adjustment. For Encounter Records (Type of Claim = 3, C, W), the date the managed care organization paid the provider for the claim or adjustment.	The date Medicaid paid this claim or adjustment.
09/21/2023	3.13.0	PRV.006.089	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	ELG.003.057	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	TPL.006.073	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	TPL.003.030	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	PRV.002.017	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	MCR.005.064	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	MCR.002.017	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	ELG.022.258	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	ELG.002.017	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	CRX.003.109	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	COT.003.155	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	CLT.003.185	UPDATE	Segment key field identifier	Not Applicable	1
09/21/2023	3.13.0	CIP.003.232	UPDATE	Segment key field identifier	Not Applicable	1
08/15/2023	3.12.0	CLT.003.198	UPDATE	Coding requirement	1. Value must be in Revenue Code List (VVL)2. A Revenue Code (CE) value requires an associated Revenue Charge (CE)3. Value must be 4 characters or less4. Mandatory	1. Value must be in Revenue Code List (VVL)2. A Revenue Code value requires an associated Revenue Charge3. Value must be 4 characters or less4. Mandatory
08/15/2023	3.12.0	CIP.003.245	UPDATE	Coding requirement	1. Value must be in Revenue Code List (VVL)2. A Revenue Code (CE) value requires an associated Revenue Charge (CE)3. Value must be 4 characters or less4. Mandatory	1. Value must be in Revenue Code List (VVL)2. A Revenue Code value requires an associated Revenue Charge3. Value must be 4 characters or less4. Mandatory
09/21/2023	3.13.0	MCR.004.058	UPDATE	Segment key field identifier	Not Applicable	3
08/28/2023	3.12.0	TPL.006.081	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	TPL.006.081	UPDATE	Coding requirement	1. Value must be in State Code List (VVL)2. Value must be 2 characters3. Optional	1. Value must be in State Code List (VVL)2. Value must be 2 characters3. Situational
09/21/2023	3.13.0	MCR.007.086	UPDATE	Segment key field identifier	Not Applicable	3
08/28/2023	3.12.0	TPL.006.091	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	TPL.006.091	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/28/2023	3.12.0	TPL.006.090	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	TPL.006.090	UPDATE	Coding requirement	1. Value must be 10 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 10 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	TPL.006.084	UPDATE	Segment key field identifier	Not Applicable	(a)
08/28/2023	3.12.0	TPL.006.083	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	TPL.006.083	UPDATE	Coding requirement	1. Value must be 10-digit number2. Optional	1. Value must be 10-digit number2. Situational
08/28/2023	3.12.0	TPL.006.082	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	TPL.006.082	UPDATE	Coding requirement	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Optional	1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Situational
08/28/2023	3.12.0	TPL.006.080	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	TPL.006.080	UPDATE	Coding requirement	1. Value must be 28 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 28 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/14/2023	3.12.0	TPL.006.079	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 (CE) or Address Line 2 (CE) value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Conditional
08/14/2023	3.12.0	TPL.006.078	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 (CE) or Address Line 3 (CE) value(s)3. There must be an Address Line 1 (CE) in order to have an Address Line 2 (CE)4. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional
08/14/2023	3.12.0	TPL.006.077	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 (CE) or Address Line 3 (CE) value(s)3. Value must not contain a pipe or asterisk symbols4. Optional5. When populated, the associated Address Type is required	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 or Address Line 3 value(s)3. Value must not contain a pipe or asterisk symbols4. Optional5. When populated, the associated Address Type is required
09/21/2023	3.13.0	TPL.006.076	UPDATE	Segment key field identifier	Not Applicable	3
09/21/2023	3.13.0	TPL.006.075	UPDATE	Segment key field identifier	Not Applicable	2
08/15/2023	3.12.0	TPL.006.074	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	TPL.005.070	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	TPL.005.068	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	TPL.005.067	UPDATE	Segment key field identifier	Not Applicable	3
08/15/2023	3.12.0	TPL.005.065	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	TPL.004.061	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	TPL.004.059	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	TPL.004.058	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	TPL.004.056	UPDATE	Segment key field identifier	Not Applicable	3
08/15/2023	3.12.0	TPL.004.054	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
09/21/2023	3.13.0	TPL.003.089	UPDATE	Segment key field identifier	Not Applicable	7
08/21/2023	3.12.0	TPL.003.050	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	TPL.003.048	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	TPL.003.036	UPDATE	Segment key field identifier	Not Applicable	6
09/21/2023	3.13.0	TPL.003.035	UPDATE	Segment key field identifier	Not Applicable	5
09/21/2023	3.13.0	TPL.003.034	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	TPL.003.033	UPDATE	Segment key field identifier	Not Applicable	3
07/13/2023	3.10.0	TPL.003.032	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
08/15/2023	3.12.0	TPL.003.031	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	TPL.002.027	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	TPL.002.025	UPDATE	Segment key field identifier	Not Applicable	(a)
08/28/2023	3.12.0	TPL.002.020	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in TPL Health Insurance Coverage Indicator List (VVL)4. Value must be 1 character5. Mandatory6. When value equals '1', there must be one corresponding TPL Medicaid Eligible Person Health Insurance Coverage Information (TPL.003) segment with the same MSIS ID.	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in TPL Health Insurance Coverage Indicator List (VVL)4. Mandatory5. When value equals '1', there must be one corresponding TPL Medicaid Eligible Person Health Insurance Coverage Information (TPL.003) segment with the same MSIS ID.
08/14/2023	3.12.0	TPL.002.018	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	TPL.001.014	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	TPL.001.012	UPDATE	Coding requirement	1. Value must be in SSN Indicator List (VVL)2. Value must be 1 character3. Mandatory	1. Value must be in SSN Indicator List (VVL)2. Value must be 1 character3. Mandatory4. When populated, value must equal SSN Indicator (ELG.001.012)
08/14/2023	3.12.0	TPL.001.010	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. Value of the CC component must be "20"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created (CE)5. Value must be equal to or after associated Start of Time Period (CE)6. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. Value of the CC component must be "20"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created5. Value must be equal to or after associated Start of Time Period6. Mandatory
08/14/2023	3.12.0	TPL.001.009	UPDATE	Coding requirement	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created (CE)5. Value must be before associated End of Time Period (CE)6. Mandatory	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created5. Value must be before associated End of Time Period6. Mandatory
08/14/2023	3.12.0	TPL.001.008	UPDATE	Coding requirement	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be less than current date5. Value must be equal to or after the value of associated End of Time Period (CE)6. Mandatory	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be less than current date5. Value must be equal to or after the value of associated End of Time Period6. Mandatory
08/28/2023	3.12.0	TPL.001.002	UPDATE	Coding requirement	1. Value must be 10 characters or less2. Value must not include the pipe ("\|") symbol3. Mandatory	1. Value must be 10 characters or less2. Value must be in the Data Dictionary Version List (VVL)3. Mandatory
08/21/2023	3.12.0	PRV.010.136	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	PRV.010.134	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	PRV.010.130	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	PRV.010.129	UPDATE	Segment key field identifier	Not Applicable	3
08/15/2023	3.12.0	PRV.010.127	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	PRV.009.123	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	PRV.009.121	UPDATE	Segment key field identifier	Not Applicable	(a)
06/14/2023	3.9.0	PRV.009.120	UPDATE	Definition	A data element to identify the Medicaid/CHIP programs, waivers and demonstrations in which the provider participates. If Affiliated Program Type = 2 (Health Plan State-assigned health plan ID), then the value in Affiliated Program ID is the state-assigned plan ID of the health plan in which a provider is enrolled to provide services. If Affiliated Program Type = 3 (Waiver), then the value in Affiliated Program ID is the core Federal Waiver ID in which a provider is allowed to deliver services to eligible beneficiaries. If Affiliated Program Type = 4 (Health Home Entity), then the value in Affiliated Program ID is the name of a health home in which a provider is participating. If Affiliated Program Type = 5 (Other), then the value in Affiliated Program ID is an identifier for something other than a health plan, waiver, or health home entity.	A data element to identify the Medicaid/CHIP programs, waivers and demonstrations in which the provider participates.
09/21/2023	3.13.0	PRV.009.119	UPDATE	Segment key field identifier	Not Applicable	3
08/15/2023	3.12.0	PRV.009.117	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	PRV.008.113	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	PRV.008.111	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	PRV.008.110	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	PRV.008.108	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	PRV.007.104	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/14/2023	3.12.0	PRV.007.096	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	PRV.006.092	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	PRV.006.090	UPDATE	Segment key field identifier	Not Applicable	(a)
01/03/2023	3.2.0	PRV.006.089	UPDATE	Medicaid valid value info	*Valid values for PROV-CLASSIFICATION-CODE depend on the value submitted for PROV-CLASSIFICATION-TYPE. All four valid value sets are shown here below.If PROV-CLASSIFICATION-TYPE = 1 then you should submit a valid value from the PROV-CLASSIFICATION-CODE-TYPE-1 valid value set.If PROV-CLASSIFICATION-TYPE = 2 then you should submit a valid value from the PROV-SPECIALTY valid value set.If PROV-CLASSIFICATION-TYPE = 3 then you should submit a valid value from the PROV-TYPE valid value set.If PROV-CLASSIFICATION-TYPE = 4 then you should submit a valid value from the PROV-CLASSIFICATION-CODE-TYPE-4 valid value set.	*Valid values for PROV-CLASSIFICATION-CODE depend on the value submitted for PROV-CLASSIFICATION-TYPE. All four valid value sets are shown here below.If PROV-CLASSIFICATION-TYPE = 1 then refer to the Provider Taxonomy Code ListIf PROV-CLASSIFICATION-TYPE = 2 then you should submit a valid value from the PROV-SPECIALTY valid value set.If PROV-CLASSIFICATION-TYPE = 3 then you should submit a valid value from the PROV-TYPE valid value set.If PROV-CLASSIFICATION-TYPE = 4 then you should submit a valid value from the PROV-CLASSIFICATION-CODE-TYPE-4 valid value set.
01/26/2023	3.2.0	PRV.006.088	UPDATE	Definition	A code to identify the schema used in the Provider Classification Code field to categorize providers. See T-MSIS Guidance Document, "CMS Guidance: Best Practice for Reporting Provider Classification Type and Provider Classification Code in the T-MSIS Provider File" https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47562 A provider may be reported with multiple active record segments with the same Provider Classification Type if different Provider Classification Code values apply.	A code to identify the schema used in the Provider Classification Code field to categorize providers. See T-MSIS Guidance Document, "CMS Guidance: Best Practice for Reporting Provider Classification Type and Provider Classification Code in the T-MSIS Provider File" https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/98581 . A provider may be reported with multiple active record segments with the same Provider Classification Type if different Provider Classification Code values apply.
08/14/2023	3.12.0	PRV.006.086	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	PRV.005.082	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	PRV.005.081	UPDATE	Segment key field identifier	Not Applicable	6
09/21/2023	3.13.0	PRV.005.079	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	PRV.005.078	UPDATE	Segment key field identifier	Not Applicable	5
09/21/2023	3.13.0	PRV.005.077	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	PRV.005.076	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	PRV.005.074	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	PRV.004.070	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	PRV.004.069	UPDATE	Segment key field identifier	Not Applicable	6
09/21/2023	3.13.0	PRV.004.068	UPDATE	Segment key field identifier	Not Applicable	5
09/21/2023	3.13.0	PRV.004.067	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	PRV.004.065	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	PRV.004.064	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	PRV.004.062	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	PRV.003.058	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/15/2023	3.12.0	PRV.003.054	UPDATE	Coding requirement	1. Must contain the '@' symbol2. May contain uppercase and lowercase Latin letters A to Z and a to z3. May contain digits 0-94. Must contain a dot '.' that is not the first or last character and provided that it does not appear consecutively5. Value must be 60 characters or less6. Optional	1. Must contain the '@' symbol2. May contain uppercase and lowercase Latin letters A to Z and a to z3. May contain digits 0-94. Must contain a dot '.' that is not the first or last character and provided that it does not appear consecutively5. Value must be 60 characters or less6. Situational
08/15/2023	3.12.0	PRV.003.053	UPDATE	Coding requirement	1. Value must be 10-digit number2. Optional	1. Value must be 10-digit number2. Situational
09/21/2023	3.13.0	PRV.003.052	UPDATE	Medicaid valid value info		Zip Code List
08/14/2023	3.12.0	PRV.003.049	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 (CE) or Address Line 2 (CE) value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Conditional
08/14/2023	3.12.0	PRV.003.048	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 (CE) or Address Line 3 (CE) value(s)3. There must be an Address Line 1 (CE) in order to have an Address Line 2 (CE)4. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional
08/14/2023	3.12.0	PRV.003.047	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 (CE) or Address Line 3 (CE) value(s)3. Value must not contain a pipe or asterisk symbols4. Mandatory5. When populated, the associated Address Type is required	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 or Address Line 3 value(s)3. Value must not contain a pipe or asterisk symbols4. Mandatory5. When populated, the associated Address Type is required
09/21/2023	3.13.0	PRV.003.046	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	PRV.003.044	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	PRV.003.043	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	PRV.003.041	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	PRV.002.037	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/28/2023	3.12.0	PRV.002.035	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Conditional4. If populated, value must be on or after individual's Date of Birth5. Value must be less than or equal to associated End of Time Period (PRV.001.010)6. There can only be one value on all records when the value is populated7. When populated, the difference between value and Date of Birth (PRV.002.034) must be 18 years or greater	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Conditional4. When populated, value must be on or after individual's Date of Birth5. Value must be less than or equal to associated End of Time Period (PRV.001.010)6. There can only be one value on all records when the value is populated7. When populated, the difference between value and Date of Birth (PRV.002.034) must be 18 years or greater
08/28/2023	3.12.0	PRV.002.026	UPDATE	Coding requirement	1. Value must be in Facility Group Individual Code List (VVL)2. Value must be 2 characters3. Mandatory4. (individual) if value equals '03', then Provider First Name (PRV.002.028) must be populated5. (organization) if value does not equal '03', then Provider Middle Initial (PRV.002.029) must not be populated6. (individual) if value equals '03', then Provider Last Name (PRV.002.030) must be populated7. (individual) if value equals '03', then Provider Sex (PRV.002.031) must be populated8. (individual) if value equals '03', then Provider Date of Birth (PRV.002.034) must be populated9. (organization) if value equals '01' or '02', then Provider Date of Death (PRV.002.035) must not be populated	1. Value must be in Facility Group Individual Code List (VVL)2. Value must be 2 characters3. Mandatory4. (individual) if value equals '03', then Provider First Name (PRV.002.028) must be populated5. (organization) if value does not equal '03', then Provider Middle Initial (PRV.002.029) must not be populated6. (individual) if value equals '03', then Provider Last Name (PRV.002.030) must be populated7. (individual) if value equals '03', then Provider Sex (PRV.002.031) must be populated8. (individual) if value equals '03', then Provider Date of Birth (PRV.002.034) must be populated9. (organization) if value equals '01' or '02', then Provider Date of Death (PRV.002.035) must not be populated10. (individual) if value equals '03', then there must be one Provider Identifier (PRV.005.081) populated with an associated Provider Identifier Type (PRV.005.077) equal to ‘2’ (NPI)
08/09/2023	3.11.0	PRV.002.024	UPDATE	Definition	The name of the provider when the provider is an organization. If the provider organization name exceeds 60 characters submit only the first 60 characters of the name.	The name of the provider when the provider is an organization. If the provider organization name exceeds 60 characters submit only the first 60 characters of the name. Provider Organization Name should be same as provider last name when provider is an individual.
09/21/2023	3.13.0	PRV.002.020	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	PRV.002.019	UPDATE	Segment key field identifier	Not Applicable	2
08/14/2023	3.12.0	PRV.002.018	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	PRV.001.014	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/14/2023	3.12.0	PRV.001.010	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. Value of the CC component must be "20"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created (CE)5. Value must be equal to or after associated Start of Time Period (CE)6. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. Value of the CC component must be "20"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created5. Value must be equal to or after associated Start of Time Period6. Mandatory
08/14/2023	3.12.0	PRV.001.009	UPDATE	Coding requirement	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created (CE)5. Value must be before associated End of Time Period (CE)6. Mandatory	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created5. Value must be before associated End of Time Period6. Mandatory
08/14/2023	3.12.0	PRV.001.008	UPDATE	Coding requirement	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be less than current date5. Value must be equal to or after the value of associated End of Time Period (CE)6. Mandatory	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be less than current date5. Value must be equal to or after the value of associated End of Time Period6. Mandatory
08/28/2023	3.12.0	PRV.001.002	UPDATE	Coding requirement	1. Value must be 10 characters or less2. Value must not include the pipe ("\|") symbol3. Mandatory	1. Value must be 10 characters or less2. Value must be in the Data Dictionary Version List (VVL)3. Mandatory
08/21/2023	3.12.0	MCR.007.089	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	MCR.007.087	UPDATE	Segment key field identifier	Not Applicable	(a)
08/14/2023	3.12.0	MCR.007.084	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	MCR.006.080	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	MCR.006.078	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	MCR.006.077	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	MCR.006.075	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	MCR.005.071	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	MCR.005.069	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	MCR.005.068	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	MCR.005.067	UPDATE	Segment key field identifier	Not Applicable	3
09/21/2023	3.13.0	MCR.005.066	UPDATE	Segment key field identifier	Not Applicable	2
08/14/2023	3.12.0	MCR.005.065	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	MCR.004.061	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	MCR.004.059	UPDATE	Segment key field identifier	Not Applicable	(a)
08/14/2023	3.12.0	MCR.004.056	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	MCR.003.052	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/28/2023	3.12.0	MCR.003.051	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	MCR.003.051	UPDATE	Coding requirement	Optional	1. Value must be a 10-digit number2. Situational
08/28/2023	3.12.0	MCR.003.050	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	MCR.003.050	UPDATE	Coding requirement	1. Must contain the '@' symbol2. May contain uppercase and lowercase Latin letters A to Z and a to z3. May contain digits 0-94. Must contain a dot '.' that is not the first or last character and provided that it does not appear consecutively5. Value must be 60 characters or less6. Optional	Must contain the '@' symbol2. May contain uppercase and lowercase Latin letters A to Z and a to z3. May contain digits 0-94. Must contain a dot '.' that is not the first or last character and provided that it does not appear consecutively5. Value must be 60 characters or less6. Situational
08/28/2023	3.12.0	MCR.003.049	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	MCR.003.049	UPDATE	Coding requirement	1. Value must be 10-digit number2. Optional	1. Value must be 10-digit number2. Situational
09/21/2023	3.13.0	MCR.003.047	UPDATE	Medicaid valid value info		Zip Code List
08/14/2023	3.12.0	MCR.003.043	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 (CE) or Address Line 3 (CE) value(s)3. There must be an Address Line 1 (CE) in order to have an Address Line 2 (CE)4. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional
08/14/2023	3.12.0	MCR.003.042	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 (CE) or Address Line 3 (CE) value(s)3. Value must not contain a pipe or asterisk symbols4. Mandatory5. When populated, the associated Address Type is required	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 or Address Line 3 value(s)3. Value must not contain a pipe or asterisk symbols4. Mandatory5. When populated, the associated Address Type is required
09/21/2023	3.13.0	MCR.003.041	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	MCR.003.039	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	MCR.003.038	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	MCR.003.036	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	MCR.002.032	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	MCR.002.030	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	MCR.002.024	UPDATE	Segment key field identifier	Not Applicable	3
09/21/2023	3.13.0	MCR.002.019	UPDATE	Segment key field identifier	Not Applicable	2
08/14/2023	3.12.0	MCR.002.018	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	MCR.001.014	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/14/2023	3.12.0	MCR.001.010	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. Value of the CC component must be "20"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created (CE)5. Value must be equal to or after associated Start of Time Period (CE)6. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. Value of the CC component must be "20"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created5. Value must be equal to or after associated Start of Time Period6. Mandatory
08/14/2023	3.12.0	MCR.001.009	UPDATE	Coding requirement	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created (CE)5. Value must be before associated End of Time Period (CE)6. Mandatory	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created5. Value must be before associated End of Time Period6. Mandatory
08/14/2023	3.12.0	MCR.001.008	UPDATE	Coding requirement	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be less than current date5. Value must be equal to or after the value of associated End of Time Period (CE)6. Mandatory	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be less than current date5. Value must be equal to or after the value of associated End of Time Period6. Mandatory
08/28/2023	3.12.0	MCR.001.002	UPDATE	Coding requirement	1. Value must be 10 characters or less2. Value must not include the pipe ("\|") symbol3. Mandatory	1. Value must be 10 characters or less2. Value must be in the Data Dictionary Version List (VVL)3. Mandatory
08/21/2023	3.12.0	ELG.022.267	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/28/2023	3.12.0	ELG.022.265	UPDATE	Coding requirement	1. Value must be 20 characters or less2. Mandatory3. Must not contain a pipe symbol	1. Value must be 20 characters or less2. Mandatory3. Must not contain a pipe or asterisk symbol
09/21/2023	3.13.0	ELG.022.263	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	ELG.022.261	UPDATE	Segment key field identifier	Not Applicable	3
07/13/2023	3.10.0	ELG.022.260	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
08/14/2023	3.12.0	ELG.022.259	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	ELG.021.255	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	ELG.021.253	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	ELG.021.252	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	ELG.021.250	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	ELG.020.245	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	ELG.020.243	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	ELG.020.242	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	ELG.020.240	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	ELG.018.236	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	ELG.018.234	UPDATE	Segment key field identifier	Not Applicable	(a)
08/01/2023	3.11.0	ELG.018.233	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Conditional
08/14/2023	3.12.0	ELG.018.231	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	ELG.017.227	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	ELG.017.225	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	ELG.017.224	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	ELG.017.222	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	ELG.016.218	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	ELG.016.216	UPDATE	Segment key field identifier	Not Applicable	(a)
08/01/2023	3.11.0	ELG.016.215	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in American Indian Alaskan Native Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in American Indian Alaskan Native Indicator List (VVL)4. Conditional
09/21/2023	3.13.0	ELG.016.214	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	ELG.016.213	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	ELG.016.211	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/28/2023	3.12.0	ELG.015.271	UPDATE	Coding requirement	1. Value must be 25 characters or less2. Value is required when Ethnicity Code (ELG.015.204) equals '4' (Other)3. Conditional	1. Value must be 25 characters or less2. If associated Ethnicity Code (ELG.015.204) is in ["4"], then value must be populated. 3. Conditional
08/21/2023	3.12.0	ELG.015.207	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	ELG.015.205	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	ELG.015.204	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	ELG.015.202	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	ELG.014.198	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	ELG.014.193	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	ELG.014.192	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	ELG.014.190	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	ELG.013.186	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	ELG.013.184	UPDATE	Segment key field identifier	Not Applicable	(a)
08/28/2023	3.12.0	ELG.013.183	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Mandatory	1. Value must be 30 characters or less2. Mandatory3. Value must match a corresponding Provider Identifier (PRV.005.081)
09/21/2023	3.13.0	ELG.013.182	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	ELG.013.180	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	ELG.012.176	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	ELG.012.174	UPDATE	Segment key field identifier	Not Applicable	(a)
08/15/2023	3.12.0	ELG.012.172	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type (CE)2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Value must have a corresponding value in Waiver Type (ELG.012.173)6. Mandatory	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Value must have a corresponding value in Waiver Type (ELG.012.173)6. Mandatory
08/14/2023	3.12.0	ELG.012.170	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	ELG.011.166	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	ELG.011.164	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	ELG.011.163	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	ELG.011.161	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	ELG.010.157	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/14/2023	3.12.0	ELG.010.148	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
07/12/2023	3.10.0	ELG.009.270	UPDATE	Coding requirement	1. Value must be 3 characters2. Conditional	1. Value must be 3 characters2. Conditional3. Must be a 3 digit value from the Type-of-Service valid value list
08/21/2023	3.12.0	ELG.009.144	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	ELG.009.142	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	ELG.009.141	UPDATE	Segment key field identifier	Not Applicable	4
08/28/2023	3.12.0	ELG.009.140	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Mandatory	1. Value must be 30 characters or less2. Mandatory3. Value must match a corresponding Provider Identifier (PRV.005.081)
08/14/2023	3.12.0	ELG.009.138	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	ELG.008.134	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	ELG.008.132	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	ELG.008.131	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	ELG.008.130	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	ELG.008.128	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	ELG.007.124	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	ELG.007.121	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	ELG.007.120	UPDATE	Segment key field identifier	Not Applicable	5
09/21/2023	3.13.0	ELG.007.119	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	ELG.007.118	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	ELG.007.116	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	ELG.006.112	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	ELG.006.109	UPDATE	Segment key field identifier	Not Applicable	(a)
09/21/2023	3.13.0	ELG.006.108	UPDATE	Segment key field identifier	Not Applicable	4
09/21/2023	3.13.0	ELG.006.107	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	ELG.006.105	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	ELG.005.101	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
01/09/2023	3.2.0	ELG.005.095	UPDATE	Definition	The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed.	The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed. If for a single termination in eligibility for a single individual, there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another.
08/16/2023	3.12.0	ELG.005.094	UPDATE	Coding requirement	1. Value must be in Conception to Birth Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If the value is equal to "1", then the Eligibility Group (ELG.005.087) must equal "64"5. If the value is equal to "1", then any associated claims must indicate the Program Type = '14' (State Plan CHIP)6. If the value is equal to "1", then CHIP Code (ELG.003.054) must equal "3" (Individual was not Medicaid Expansion CHIP eligible, but was included in a separate title XXI CHIP Program)7. Value must be 1 character8. Conditional	1. Value must be in Conception to Birth Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If the value is equal to "1", then the Eligibility Group (ELG.005.087) must equal "64"5. If the value is equal to "1", then any associated claims must indicate the Program Type = '14' (State Plan CHIP)6. If the value is equal to "1", then CHIP Code (ELG.003.054) must equal "3" (Individual was not Medicaid Expansion CHIP eligible, but was included in a separate title XXI CHIP Program)7. Conditional
09/21/2023	3.13.0	ELG.005.091	UPDATE	Coding requirement	1. Value must be in SSI State Supplement Status Code List (VVL)2. Value must be 3 characters3. (individual not receiving Federal SSI)If value is "001" or "002", then SSI Status (ELG.005.092) must be "001" or "002"4. (Individual not receiving Federal SSI)If value is "001" or "002", then SSI Indicator (ELG.005.090) must be '1'5. Value must not be populated or must be '000' when SSI Status (ELG.005.092) is not populated or is '000'	1. Value must be in SSI State Supplement Status Code List (VVL)2. Value must be 3 characters3. (individual not receiving Federal SSI)If value is "001" or "002", then SSI Status (ELG.005.092) must be "001" or "002"4. (Individual not receiving Federal SSI)If value is "001" or "002", then SSI Indicator (ELG.005.090) must be "1"5. Value must not be populated or must be "000" when SSI Status (ELG.005.092) is not populated or is "000"
09/21/2023	3.13.0	ELG.005.089	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in SSDI Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in SSDI Indicator List (VVL)4. Conditional
08/28/2023	3.12.0	ELG.005.087	UPDATE	Coding requirement	1. Value must be in Eligibility Group List (VVL)2. If value is "26", then Dual Eligible Code value must be "06"3. Conditional4. Value is mandatory and must be provided when associated Eligibility Determinant Effective Date value is on or after 1 January, 2014.5. If value is in [ "72", "73", "74", "75" ], then associated Restricted Benefits Code value must equal "1" or "7" and State Plan Option Type must equal "06"6. If associated CHIP Code value is "2", then value must be in [ "07", 31", "61" ]7. If associated CHIP Code value is "3", then value must be in [ "61", "62", "63", "64", "65", "66", "67", "68" ]8. Value must be 2 characters9. If value is "23", then Dual Eligible Code value must be in ["01", "02"]10. If value is "25", then Dual Eligible Code value must be in ["03", "04"]11. If value is "24", then Dual Eligible Code value must be "05"	Value must be in Eligibility Group List (VVL)2. If value is "26", then Dual Eligible Code value must be "06"3. Conditional4. Value is mandatory and must be provided when associated Eligibility Determinant Effective Date value is on or after 1 January, 2014.5. If value is in [ "72", "73", "74", "75" ], then associated Restricted Benefits Code value must equal "1" or "7" and State Plan Option Type must equal "06"6. If associated CHIP Code value is "2", then value must be in [ "07", 31", "61" ]7. If associated CHIP Code value is "3", then value must be in [ "61", "62", "63", "64", "65", "66", "67", "68" ]8. Value must be 2 characters9. If value is "23", then Dual Eligible Code value must be in ["01", "02"]10. If value is "25", then Dual Eligible Code value must be in ["03", "04"]11. If value is "24", then Dual Eligible Code value must be "05"12. If value is "26", then Dual Eligible Code value must be "06"
05/31/2023	3.8.0	ELG.005.085	UPDATE	Necessity	Conditional	Mandatory
05/31/2023	3.8.0	ELG.005.085	UPDATE	Coding requirement	1. Value must be in Dual Eligible Code List (VVL)2. If value is "05", then Eligibility Group (ELG.005.087) must be "24"3. If value is "06", then Eligibility Group (ELG.005.087) must be "26"4. If Dual Eligible Code (ELG.005.085) is "01", "02", "03", 04", 05", "06", "08", "09", or "10", then Primary Eligibility Group Indicator (ELG.005.086) must be "1" (Yes)5. Conditional6. A partial dual eligible (values="01', "03", "05" or "06") then Restricted Benefits Code (ELG.005.097) must be "3"7. (Not Dual Eligible) if value = "00", then associated Medicare Beneficiary Identifier (ELG.003.051) value must not be populated.8. Value must be 2 characters9. If value is in ["08", "10"] then Restricted Benefits Code (ELG.005.097) must be "1"10. If value is "09", then Eligibility Group (ELG.005.087) and Restricted Benefits Code (ELG.005.097) must not be populated11. If value equals "10", then CHIP Code (ELG.003.054) must be "03" (S-CHIP) and Medicare Beneficiary Identifier (ELG.003.051) must be populated12. If value is "01", then Eligibility Group (ELG.005.087) must be "23"13. If value is "03", then Eligibility Group (ELG.005.087) must be "25"	1. Value must be in Dual Eligible Code List (VVL)2. If value is "05", then Eligibility Group (ELG.005.087) must be "24"3. If value is "06", then Eligibility Group (ELG.005.087) must be "26"4. If Dual Eligible Code (ELG.005.085) is "01", "02", "03", 04", 05", "06", "08", "09", or "10", then Primary Eligibility Group Indicator (ELG.005.086) must be "1" (Yes)5. Mandatory6. A partial dual eligible (values="01', "03", "05" or "06") then Restricted Benefits Code (ELG.005.097) must be "3"7. (Not Dual Eligible) if value = "00", then associated Medicare Beneficiary Identifier (ELG.003.051) value must not be populated.8. Value must be 2 characters9. If value is in ["08", "10"] then Restricted Benefits Code (ELG.005.097) must be "1"10. If value is "09", then Eligibility Group (ELG.005.087) and Restricted Benefits Code (ELG.005.097) must not be populated11. If value equals "10", then CHIP Code (ELG.003.054) must be "03" (S-CHIP) and Medicare Beneficiary Identifier (ELG.003.051) must be populated12. If value is "01", then Eligibility Group (ELG.005.087) must be "23"13. If value is "03", then Eligibility Group (ELG.005.087) must be "25"
09/21/2023	3.13.0	ELG.005.083	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	ELG.005.081	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	ELG.004.077	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	ELG.004.075	UPDATE	Segment key field identifier	Not Applicable	(a)
08/09/2023	3.11.0	ELG.004.074	UPDATE	Definition	A free-form text field to describe the type of living arrangement used for the eligibility determination process. The field will remain a free-form text data element until MACPro develops a list of valid values. When it becomes available, T-MSIS will align with MACPro valid value lists.	A free-form text field to describe the type of living arrangement used for the eligibility determination process.
08/28/2023	3.12.0	ELG.004.073	UPDATE	Coding requirement	1. Value must be 10-digit number2. Conditional	1. Value must be 10-digit number2. Conditional3. If Eligible Address Type (ELG.004.065) = ''01', then value is mandatory and must be provided
08/14/2023	3.12.0	ELG.004.068	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 (CE) or Address Line 2 (CE) value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Conditional
08/14/2023	3.12.0	ELG.004.067	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 (CE) or Address Line 3 (CE) value(s)3. There must be an Address Line 1 (CE) in order to have an Address Line 2 (CE)4. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional
08/14/2023	3.12.0	ELG.004.066	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 (CE) or Address Line 3 (CE) value(s)3. Value must not contain a pipe or asterisk symbols4. Mandatory5. When populated, the associated Address Type is required	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 or Address Line 3 value(s)3. Value must not contain a pipe or asterisk symbols4. Mandatory5. When populated, the associated Address Type is required
09/21/2023	3.13.0	ELG.004.065	UPDATE	Segment key field identifier	Not Applicable	3
08/14/2023	3.12.0	ELG.004.063	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
07/14/2023	3.10.0	ELG.003.269	UPDATE	Definition	This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the one that applies to their primary eligibility group.	This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.
08/21/2023	3.12.0	ELG.003.059	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/01/2023	3.11.0	ELG.003.049	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Pregnancy Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Pregnancy Indicator List (VVL)4. Conditional
07/12/2023	3.10.0	ELG.003.040	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Citizenship Indicator List (VVL)4. If value is coded as '0', then associated Immigration Status (ELG.003.042) value must be in [ 1, 2, 3 ]5. If value is coded as '1', then associated Immigration Status (ELG.003.042) value must equal '8'6. Value must be 1 character7. Mandatory	1. Value must be 1 character2. Value must be in [0, 1, 2] or not populated3. Value must be in Citizenship Indicator List (VVL)4. If value is coded as '0', then associated Immigration Status (ELG.003.042) value must be in [ 1, 2, 3 ]5. If value is coded as '1', then associated Immigration Status (ELG.003.042) value must equal '8'6. Value must be 1 character7. Mandatory
08/28/2023	3.12.0	ELG.003.039	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Veteran Indicator List (VVL)4. Value must be 1 character5. Conditional6. Value must be populated when Immigration Status (ELG.003.042) is in ['1', '2', '3']	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Veteran Indicator List (VVL)4. Conditional5. Value must be populated when Immigration Status (ELG.003.042) is in ['1', '2', '3']
05/10/2023	3.7.0	ELG.003.038	UPDATE	Necessity	Mandatory	Conditional
05/10/2023	3.7.0	ELG.003.038	UPDATE	Coding requirement	1. Value must be in Income Code List (VVL)2. Value must be 2 characters3. Mandatory	1. Value must be in Income Code List (VVL)2. Value must be 2 characters3. Conditional
06/21/2023	3.9.0	ELG.003.034	UPDATE	Definition	A code to classify eligible individual's marital/domestic-relationship status. An eligible individual who is younger than 12 years should have a marital status of never married or unknown. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization).	A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization).Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the state’s marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value.
08/14/2023	3.12.0	ELG.003.032	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	ELG.002.028	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	ELG.002.026	UPDATE	Segment key field identifier	Not Applicable	(a)
08/14/2023	3.12.0	ELG.002.024	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Children enrolled in the Separate CHIP prenatal program option should have a date of birth missing or a date of birth equal to the pregnant mother's date of birth4. When Conception to Birth Indicator (ELG.005.094) does not equal '1' and Eligibility Group (ELG.005.087) does not equal '64' value must be less than or equal to associated End of Time Period (CE) value5. Value must be less than or equal to associated Date File Created (ELG.001.008) value6. Mandatory7. When Conception to Birth Indicator (ELG.005.094) does not equal '1' and Eligibility Group (ELG.005.087) does not equal '64' value minus Start of Time Period (ELG.001.10) must be less than 125 years	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Children enrolled in the Separate CHIP prenatal program option should have a date of birth missing or a date of birth equal to the pregnant mother's date of birth4. When Conception to Birth Indicator (ELG.005.094) does not equal '1' and Eligibility Group (ELG.005.087) does not equal '64' value must be less than or equal to associated End of Time Period value5. Value must be less than or equal to associated Date File Created (ELG.001.008) value6. Mandatory7. When Conception to Birth Indicator (ELG.005.094) does not equal '1' and Eligibility Group (ELG.005.087) does not equal '64' value minus Start of Time Period (ELG.001.10) must be less than 125 years
07/13/2023	3.10.0	ELG.002.019	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less	1. Mandatory2. Value must be 20 characters or less
08/14/2023	3.12.0	ELG.002.018	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	ELG.001.014	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/14/2023	3.12.0	ELG.001.009	UPDATE	Coding requirement	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created (CE)5. Value must be before associated End of Time Period (CE)6. Mandatory	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created5. Value must be before associated End of Time Period6. Mandatory
08/14/2023	3.12.0	ELG.001.008	UPDATE	Coding requirement	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be less than current date5. Value must be equal to or after the value of associated End of Time Period (CE)6. Mandatory	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be less than current date5. Value must be equal to or after the value of associated End of Time Period6. Mandatory
08/28/2023	3.12.0	ELG.001.002	UPDATE	Coding requirement	1. Value must be 10 characters or less2. Value must not include the pipe ("\|") symbol3. Mandatory	1. Value must be 10 characters or less2. Value must be in the Data Dictionary Version List (VVL)3. Mandatory
02/16/2023	3.3.0	CRX.003.172	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated	1. Value must be 1 character2. Value must be in [0, 1]
09/21/2023	3.13.0	CRX.003.157	UPDATE	Segment key field identifier	Not Applicable	7
08/21/2023	3.12.0	CRX.003.153	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/01/2023	3.12.0	CRX.003.127	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional4. Value should not be populated if associated Crossover Indicator value is '0' (not a crossover claim)5. If value is greater than '0,' then Crossover Indicator must be '1'	Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional4. If associated Crossover Indicator value is '0' (not a crossover claim), value should not be populated5. If value is greater than '0,' then Crossover Indicator must be '1'
08/14/2023	3.12.0	CRX.003.126	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim (CE) value equals '3, C, W', then value is mandatory and must be provided4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim value equals '3, C, W', then value is mandatory and must be provided4. Conditional
08/09/2023	3.11.0	CRX.003.125	UPDATE	Definition	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/28/2023	3.12.0	CRX.003.123	UPDATE	Necessity	Conditional	Situational
08/28/2023	3.12.0	CRX.003.123	UPDATE	Coding requirement	1. Conditional2. Value must be 5 digits or less left of the decimal i.e. 99999.99	1. Situational2. Value must be 5 digits or less left of the decimal i.e. 99999.99
08/09/2023	3.11.0	CRX.003.122	UPDATE	Definition	The maximum amount displayed at the claim line level as determined by the payer as being "allowable" under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization.	The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity allowed at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/09/2023	3.11.0	CRX.003.121	UPDATE	Definition	The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan.	The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/01/2023	3.12.0	CRX.003.120	UPDATE	Coding requirement	1. Value must be 12 digits or less2. Value must be a valid National Drug Code3. Mandatory4. Value must have an associated Metric Decimal Quantity (CRX.003.144)5. Value must have an associated Unit of Measure (CRX.003.133)	1. Value must be 12 digits or less2. Value must be a valid National Drug Code3. Mandatory4. Value must have an associated Dtl Metric Decimal Quantity (CRX.003.144)5. Value must have an associated Unit of Measure (CRX.003.133)
09/21/2023	3.13.0	CRX.003.115	UPDATE	Segment key field identifier	Not Applicable	5
09/21/2023	3.13.0	CRX.003.114	UPDATE	Segment key field identifier	Not Applicable	4
08/28/2023	3.12.0	CRX.003.113	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [‘4’, ‘1’] then value must be populated
09/21/2023	3.13.0	CRX.003.112	UPDATE	Segment key field identifier	Not Applicable	2
07/13/2023	3.10.0	CRX.003.111	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less5. When TYPE-OF-CLAIM = 4, D or X (lump sum payment), value must begin with an '&'	1. Mandatory2. Value must be 20 characters or less3. When TYPE-OF-CLAIM = 4, D or X (lump sum payment), value must begin with an '&'
08/14/2023	3.12.0	CRX.003.110	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/10/2023	3.11.0	CRX.002.165	UPDATE	Definition	The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible.	The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability minus previous beneficiary payments that went toward their deductible. Do not subtract out any payments for the given claim that went toward the deductible.
08/10/2023	3.11.0	CRX.002.164	UPDATE	Definition	The total coinsurance amount on a claim that the beneficiary is obligated to pay for covered services. This is the total Medicaid or contract negotiated beneficiary coinsurance liability for covered service on the claim. Do not subtract out any payments made toward the copayment.	The total coinsurance amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary coinsurance liability for covered services on the claim. Do not subtract out any payments made toward the coinsurance.
08/01/2023	3.11.0	CRX.002.160	UPDATE	Coding requirement	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. Value must be 1 character5. If value equals '1', then Total Medicare Coinsurance amount must not be populated.6. If value equals '0', then Crossover Indicator must equals '0'7. If value equals '1', then Crossover Indicator must equals '1'8. Conditional	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If value equals '1', then Total Medicare Coinsurance amount must not be populated.5. If value equals '0', then Crossover Indicator must equals '0'6. If value equals '1', then Crossover Indicator must equals '1'7. Conditional
08/21/2023	3.12.0	CRX.002.106	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/28/2023	3.12.0	CRX.002.104	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. Value must exist in the NPPES NPI data file
08/23/2023	3.12.0	CRX.002.101	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Third Party Copayment Amount4. Optional	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, must have an associated Third Party Copayment Amount 4. Situational
08/23/2023	3.12.0	CRX.002.100	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Optional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Situational
08/23/2023	3.12.0	CRX.002.099	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Third Party Coinsurance Amount4. Conditional	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, value must have an associated Third Party Coinsurance Amount 4. Conditional
08/23/2023	3.12.0	CRX.002.098	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Optional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Situational
08/28/2023	3.12.0	CRX.002.095	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	CRX.002.095	UPDATE	Coding requirement	1. Value must be in Copay Waived Indicator List (VVL)2. Value must be 1 character3. Optional	1. Value must be in Copay Waived Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. Situational
09/07/2023	3.12.0	CRX.002.092	UPDATE	Definition	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their deductible for the covered services on the claim. Do not include deductible payments made by a third party/s on behalf of the beneficiary.	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their deductible for the covered services on the claim. Do not include deductible payments made by a third party/ies on behalf of the beneficiary.
09/07/2023	3.12.0	CRX.002.089	UPDATE	Definition	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on the claim. Do not include copayment payments made by a third party/s on behalf of the beneficiary.	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on the claim. Do not include copayment payments made by a third party/ies on behalf of the beneficiary.
09/07/2023	3.12.0	CRX.002.087	UPDATE	Definition	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their coinsurance for the covered services on the claim. Do not include coinsurance payments made by a third party/s on behalf of the beneficiary.	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their coinsurance for the covered services on the claim. Do not include coinsurance payments made by a third party/ies on behalf of the beneficiary.
08/01/2023	3.11.0	CRX.002.082	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Border State Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Border State Indicator List (VVL)4. Conditional
07/12/2023	3.10.0	CRX.002.081	UPDATE	Definition	The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount.	The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The RA is the detailed explanation of the reason for the payment amount.
09/21/2023	3.13.0	CRX.002.075	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Mandatory	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Mandatory4. Value must exist in the NPPES NPI data file5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)
08/15/2023	3.12.0	CRX.002.069	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type (CE)2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Conditional
08/28/2023	3.12.0	CRX.002.067	UPDATE	Coding requirement	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Value must be 1 character6. Conditional	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Conditional
08/01/2023	3.11.0	CRX.002.061	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Forced Claim Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Forced Claim Indicator List (VVL)4. Conditional
08/14/2023	3.12.0	CRX.002.060	UPDATE	Coding requirement	1. Value must be a positive integer2. Value must be between 0:9999 (inclusive)3. Value must not include commas or other non-numeric characters4. Value must be equal to the number of claim lines (e.g. Original Claim Line Number (CE) or Adjustment Claim Line Number (CE) instances) reported in the associated claim record being reported5. Value must be 4 characters or less6. Mandatory	1. Value must be a positive integer2. Value must be between 0:9999 (inclusive)3. Value must not include commas or other non-numeric characters4. Value must be equal to the number of claim lines (e.g. Original Claim Line Number or Adjustment Claim Line Number instances) reported in the associated claim record being reported5. Value must be 4 characters or less6. Mandatory
06/14/2023	3.9.0	CRX.002.058	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level.	The field denotes whether the payment amount was determined at the claim header or line/detail level.For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only.For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
06/01/2023	3.8.0	CRX.002.054	UPDATE	Coding requirement	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Conditional	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional
05/31/2023	3.8.0	CRX.002.053	UPDATE	Necessity	Mandatory	Conditional
05/31/2023	3.8.0	CRX.002.053	UPDATE	Coding requirement	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Mandatory	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Conditional
08/01/2023	3.11.0	CRX.002.052	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Fixed Payment Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Fixed Payment Indicator List (VVL)4. Conditional
08/01/2023	3.11.0	CRX.002.048	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Conditional
08/15/2023	3.12.0	CRX.002.045	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than associated Total Billed Amount (CE) - (Total Medicare Coinsurance Amount (CE) + Total Medicare Deductible Amount (CE))4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional
08/09/2023	3.11.0	CRX.002.040	UPDATE	Definition	The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization.	The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity allowed for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/09/2023	3.11.0	CRX.002.032	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted.	The field denotes the claims payment system from which the claim was extracted.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.
08/09/2023	3.11.0	CRX.002.029	UPDATE	Definition	A code to indicate what type of payment is covered in this claim.	A code to indicate what type of payment is covered in this claim.For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.
01/05/2023	3.2.0	CRX.002.028	UPDATE	Definition	The date Medicaid paid this claim or adjustment.	The date Medicaid paid this claim or adjustment. For Encounter Records (Type of Claim = 3, C, W), the date the managed care organization paid the provider for the claim or adjustment.
09/21/2023	3.13.0	CRX.002.027	UPDATE	Segment key field identifier	Not Applicable	5
08/01/2023	3.11.0	CRX.002.024	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Value must be 1 character5. Conditional6. When value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Conditional5. When value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated
08/28/2023	3.12.0	CRX.002.020	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [‘4’, ‘1’] then value must be populated
09/21/2023	3.13.0	CRX.002.019	UPDATE	Segment key field identifier	Not Applicable	2
08/14/2023	3.12.0	CRX.002.018	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	CRX.001.014	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	CRX.001.012	UPDATE	Coding requirement	1. Value must be in SSN Indicator List (VVL)2. Value must be 1 character3. Mandatory	1. Value must be in SSN Indicator List (VVL)2. Value must be 1 character3. Mandatory4. When populated, value must equal SSN Indicator (ELG.001.012)
08/14/2023	3.12.0	CRX.001.010	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. Value of the CC component must be "20"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created (CE)5. Value must be equal to or after associated Start of Time Period (CE)6. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. Value of the CC component must be "20"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created5. Value must be equal to or after associated Start of Time Period6. Mandatory
08/14/2023	3.12.0	CRX.001.009	UPDATE	Coding requirement	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created (CE)5. Value must be before associated End of Time Period (CE)6. Mandatory	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created5. Value must be before associated End of Time Period6. Mandatory
08/14/2023	3.12.0	CRX.001.008	UPDATE	Coding requirement	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be less than current date5. Value must be equal to or after the value of associated End of Time Period (CE)6. Mandatory	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be less than current date5. Value must be equal to or after the value of associated End of Time Period6. Mandatory
08/28/2023	3.12.0	CRX.001.002	UPDATE	Coding requirement	1. Value must be 10 characters or less2. Value must not include the pipe ("\|") symbol3. Mandatory	1. Value must be 10 characters or less2. Value must be in the Data Dictionary Version List (VVL)3. Mandatory
02/16/2023	3.3.0	COT.003.234	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated	1. Value must be 1 character2. Value must be in [0, 1]
09/21/2023	3.13.0	COT.003.221	UPDATE	Segment key field identifier	Not Applicable	7
08/21/2023	3.12.0	COT.003.214	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	COT.003.208	UPDATE	Medicaid valid value info		Zip Code List
08/14/2023	3.12.0	COT.003.205	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 (CE) or Address Line 3 (CE) value(s)3. There must be an Address Line 1 (CE) in order to have an Address Line 2 (CE)4. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional
08/14/2023	3.12.0	COT.003.204	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 (CE) or Address Line 3 (CE) value(s)3. Value must not contain a pipe or asterisk symbols4. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 or Address Line 3 value(s)3. Value must not contain a pipe or asterisk symbols4. Conditional
09/21/2023	3.13.0	COT.003.203	UPDATE	Medicaid valid value info		Zip Code List
08/14/2023	3.12.0	COT.003.200	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 (CE) or Address Line 3 (CE) value(s)3. There must be an Address Line 1 (CE) in order to have an Address Line 2 (CE)4. Value must not contain a pipe or asterisk symbols5. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional
08/14/2023	3.12.0	COT.003.199	UPDATE	Coding requirement	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 (CE) or Address Line 3 (CE) value(s)3. Value must not contain a pipe or asterisk symbols4. Conditional	1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 or Address Line 3 value(s)3. Value must not contain a pipe or asterisk symbols4. Conditional
09/07/2023	3.12.0	COT.003.184	UPDATE	Definition	The maximum allowable quantity of a service that may be rendered per date of service or per month. For use with CLAIMOT and CLAIMRX claims. For CLAIMIP and CLAIMOT claims/encounter records, use theRevenue center -quantity Allowedfield. NOTE: One prescription for 100 250 milligram tablets results inPrescription Quantity allowed=100.This field is only applicable when the service being billed can be quantified in discrete units, e.g., a number of visits or the number of units of a prescription/refill that were filled. For prescriptions/refills, use the Medicaid Drug Rebate definition of a unit, which is the smallest unit by which the drug is normally measured; e.g. tablet, capsule, milliliter, etc. For drugs not identifiable or dispensed by a normal unit, e.g. powder filled vials, use 1 as the number of units. The value inPrescription Quantity allowedmust correspond with the value in Unit of measure.	The maximum allowable quantity of a service that may be rendered per date of service or per month. For use with CLAIMOT and CLAIMRX claims. For CLAIMIP and CLAIMOT claims/encounter records, use the Revenue center -quantity Allowed field. NOTE: One prescription for 100 250 milligram tablets results in Prescription Quantity allowed=100.This field is only applicable when the service being billed can be quantified in discrete units, e.g., a number of visits or the number of units of a prescription/refill that were filled. For prescriptions/refills, use the Medicaid Drug Rebate definition of a unit, which is the smallest unit by which the drug is normally measured; e.g. tablet, capsule, milliliter, etc. For drugs not identifiable or dispensed by a normal unit, e.g. powder filled vials, use 1 as the number of units. The value in Prescription Quantity allowed must correspond with the value in Unit of measure.
09/07/2023	3.12.0	COT.003.183	UPDATE	Definition	The quantity of a service or product that is rendered for a specific date of service or billing time span as reported by revenue code or procedure code on the claim line. For use with CLAIMOT and CLAIMRX claims. For CLAIMIP and CLAIMOT claims/encounter records, use the Service Quantity Actual field.	The quantity of a service or product that is rendered for a specific date of service or billing time span as reported by revenue code or procedure code on the claim line. For use with CLAIMOT and CLAIMRX claims. For CLAIMIP and CLAIMOT claims/encounter records, use the Service Quantity Actual field. This field is only applicable when the service being billed can be quantified in discrete units, e.g. a number of visits or the number of units of a prescription/refill that were filled.
08/14/2023	3.12.0	COT.003.179	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim (CE) value equals '3, C, W', then value is mandatory and must be provided4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim value equals '3, C, W', then value is mandatory and must be provided4. Conditional
08/09/2023	3.11.0	COT.003.178	UPDATE	Definition	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/16/2023	3.12.0	COT.003.176	UPDATE	Coding requirement	1. Conditional2. Value must be 11 digits or less left of the decimal i.e. 99999999999.99	1. Situational2. Value must be between -99999999999.99 and 99999999999.993. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )
08/09/2023	3.11.0	COT.003.175	UPDATE	Definition	The maximum amount displayed at the claim line level as determined by the payer as being "allowable" under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization.	The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity allowed at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/09/2023	3.11.0	COT.003.174	UPDATE	Definition	The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan.	The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/21/2023	3.13.0	COT.003.161	UPDATE	Segment key field identifier	Not Applicable	5
09/21/2023	3.13.0	COT.003.160	UPDATE	Segment key field identifier	Not Applicable	4
08/28/2023	3.12.0	COT.003.159	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [‘4’, ‘1’] then value must be populated
09/21/2023	3.13.0	COT.003.158	UPDATE	Segment key field identifier	Not Applicable	2
07/13/2023	3.10.0	COT.003.157	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less5. When Type of Claim (COT.002.037) equals 4, D or X (lump sum payment) value must begin with an '&'	1. Mandatory2. Value must be 20 characters or less3. When Type of Claim (COT.002.037) equals 4, D or X (lump sum payment) value must begin with an '&'
08/14/2023	3.12.0	COT.003.156	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/10/2023	3.11.0	COT.002.232	UPDATE	Definition	The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible.	The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability minus previous beneficiary payments that went toward their deductible. Do not subtract out any payments for the given claim that went toward the deductible.
08/10/2023	3.11.0	COT.002.231	UPDATE	Definition	The total coinsurance amount on a claim that the beneficiary is obligated to pay for covered services. This is the total Medicaid or contract negotiated beneficiary coinsurance liability for covered service on the claim. Do not subtract out any payments made toward the copayment.	The total coinsurance amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary coinsurance liability for covered services on the claim. Do not subtract out any payments made toward the coinsurance.
05/31/2023	3.8.0	COT.002.229	UPDATE	Definition	The NPI of Ordering Provider represents the individual who requested the service or items being reported on this service line. Example include, but are not limited to, provider ordering diagnostic tests and medical equipment or supplies.	A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\|Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm).The NPI of Ordering Provider represents the individual who requested the service or items being reported on this service line. Example include, but are not limited to, provider ordering diagnostic tests and medical equipment or supplies.[Ordering provider information is only captured at the line level in the X12 837P format but in v3.0.0 of the T-MSIS file layout it is only captured at the header level. This discrepancy will be addressed in a future version of the T-MSIS OT file layout. Until Ordering provider information has been moved from the T-MSIS claim header to the line, there is no need to report it at the header.]
05/31/2023	3.8.0	COT.002.228	UPDATE	Definition	The Medicaid provider ID of the Ordering Provider is the individual who requested the services or items being reported on this service line. Examples include, but are not limited to, provider ordering diagnostic tests and medical equipment or supplies	The Medicaid provider ID of the Ordering Provider is the individual who requested the services or items being reported on this service line. Examples include, but are not limited to, provider ordering diagnostic tests and medical equipment or supplies. [Ordering provider information is only captured at the line level in the X12 837P format but in v3.0.0 of the T-MSIS file layout it is only captured at the header level. This discrepancy will be addressed in a future version of the T-MSIS OT file layout. Until Ordering provider information has been moved from the T-MSIS claim header to the line, there is no need to report it at the header.]
08/21/2023	3.12.0	COT.002.152	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/28/2023	3.12.0	COT.002.146	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Service (COT.003.186) equals '121', value must not be populated	Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Service (COT.003.186) equals '121', value must not be populated5. Value must exist in the NPPES NPI data file
08/23/2023	3.12.0	COT.002.143	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Third Party Copayment Amount4. Optional	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, must have an associated Third Party Copayment Amount 4. Situational
08/23/2023	3.12.0	COT.002.142	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Optional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Situational
08/23/2023	3.12.0	COT.002.141	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Third Party Coinsurance Amount4. Conditional	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, value must have an associated Third Party Coinsurance Amount 4. Conditional
08/23/2023	3.12.0	COT.002.140	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Optional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Situational
08/28/2023	3.12.0	COT.002.138	UPDATE	Coding requirement	1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Conditional	1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Conditional4. Value must be populated when an associated Type of Service (COT.003.186) equals ‘138’ (payment for health home services)5. Value must be populated when an associated claim line has a XIX MBESCBES Category of Service (COT.003.211) equals ‘45’ (health homes for substance use services)
08/28/2023	3.12.0	COT.002.137	UPDATE	Necessity	Not Applicable	Situational
08/28/2023	3.12.0	COT.002.137	UPDATE	Coding requirement	Optional	1. Value must be in Copayment Waived Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1]4. Situational
09/07/2023	3.12.0	COT.002.134	UPDATE	Definition	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their deductible for the covered services on the claim. Do not include deductible payments made by a third party/s on behalf of the beneficiary.	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their deductible for the covered services on the claim. Do not include deductible payments made by a third party/ies on behalf of the beneficiary.
09/07/2023	3.12.0	COT.002.132	UPDATE	Definition	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on the claim. Do not include copayment payments made by a third party/s on behalf of the beneficiary.	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on the claim. Do not include copayment payments made by a third party/ies on behalf of the beneficiary.
09/07/2023	3.12.0	COT.002.130	UPDATE	Definition	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their coinsurance for the covered services on the claim. Do not include coinsurance payments made by a third party/s on behalf of the beneficiary.	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their coinsurance for the covered services on the claim. Do not include coinsurance payments made by a third party/ies on behalf of the beneficiary.
08/01/2023	3.11.0	COT.002.128	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Border State Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Border State Indicator List (VVL)4. Conditional
07/12/2023	3.10.0	COT.002.126	UPDATE	Definition	The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount.	The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The RA is the detailed explanation of the reason for the payment amount.
08/28/2023	3.12.0	COT.002.118	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Value must be in the NPPES NPI data file4. Conditional
08/28/2023	3.12.0	COT.002.109	UPDATE	Coding requirement	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Value must be 1 character6. Conditional	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Conditional
08/14/2023	3.12.0	COT.002.103	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	COT.002.102	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	COT.002.101	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	COT.002.100	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	COT.002.099	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	COT.002.098	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	COT.002.096	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	COT.002.095	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	COT.002.094	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/01/2023	3.11.0	COT.002.073	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Healthcare Acquired Condition Indicator List (VVL).4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Healthcare Acquired Condition Indicator List (VVL).4. Conditional
08/01/2023	3.11.0	COT.002.072	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Forced Claim Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Forced Claim Indicator List (VVL)4. Conditional
08/14/2023	3.12.0	COT.002.070	UPDATE	Coding requirement	1. Value must be a positive integer2. Value must be between 0:9999 (inclusive)3. Value must not include commas or other non-numeric characters4. Value must be equal to the number of claim lines (e.g. Original Claim Line Number (CE) or Adjustment Claim Line Number (CE) instances) reported in the associated claim record being reported5. Value must be 4 characters or less6. Mandatory	1. Value must be a positive integer2. Value must be between 0:9999 (inclusive)3. Value must not include commas or other non-numeric characters4. Value must be equal to the number of claim lines (e.g. Original Claim Line Number or Adjustment Claim Line Number instances) reported in the associated claim record being reported5. Value must be 4 characters or less6. Mandatory
06/14/2023	3.9.0	COT.002.068	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level.	The field denotes whether the payment amount was determined at the claim header or line/detail level.For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only.For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
08/09/2023	3.11.0	COT.002.066	UPDATE	Definition	A unique number assigned by the state which represents a distinct comprehensive managed care plan, prepaid health plan, primary care case management program, a program for all-inclusive care for the elderly entity, or other approved plans.	A unique number assigned by the state which represents a distinct comprehensive managed care plan, prepaid health plan, primary care case management program, a program for all-inclusive care for the elderly entity, or other approved plans.For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report the PLAN-ID-NUMBER for the MCP (MCO, PIHP, or PAHP that has a contract with a state) that is making the payment to the sub-capitated entity or sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/01/2023	3.11.0	COT.002.064	UPDATE	Coding requirement	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. Value must be 1 character5. If value equals '1', then Total Medicare Coinsurance amount must not be populated.6. If value equals '0', then Crossover Indicator must equals '0'7. If value equals '1', then Crossover Indicator must equals '1'8. Conditional	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If value equals '1', then Total Medicare Coinsurance amount must not be populated.5. If value equals '0', then Crossover Indicator must equals '0'6. If value equals '1', then Crossover Indicator must equals '1'7. Conditional
06/01/2023	3.8.0	COT.002.063	UPDATE	Coding requirement	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Conditional	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional
05/31/2023	3.8.0	COT.002.062	UPDATE	Necessity	Mandatory	Conditional
05/31/2023	3.8.0	COT.002.062	UPDATE	Coding requirement	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Mandatory	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Conditional
08/01/2023	3.11.0	COT.002.061	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Fixed Payment Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Fixed Payment Indicator List (VVL)4. Conditional
08/01/2023	3.11.0	COT.002.057	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Conditional
08/15/2023	3.12.0	COT.002.054	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than associated Total Billed Amount (CE) - (Total Medicare Coinsurance Amount (CE) + Total Medicare Deductible Amount (CE))4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than associated Total Billed Amount- (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional
08/09/2023	3.11.0	COT.002.041	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted.	The field denotes the claims payment system from which the claim was extracted.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.For sub-capitation payments, report a SOURCE-LOCATION of '20', indicating the managed care plan is the source of payment.
08/09/2023	3.11.0	COT.002.037	UPDATE	Definition	A code to indicate what type of payment is covered in this claim.	A code to indicate what type of payment is covered in this claim.For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.
01/05/2023	3.2.0	COT.002.036	UPDATE	Definition	The date Medicaid paid this claim or adjustment.	The date Medicaid paid this claim or adjustment. For Encounter Records (Type of Claim = 3, C, W), the date the managed care organization paid the provider for the claim or adjustment.
09/21/2023	3.13.0	COT.002.035	UPDATE	Segment key field identifier	Not Applicable	5
08/01/2023	3.11.0	COT.002.024	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Value must be 1 character5. Conditional6. When value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Conditional5. When value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated
08/28/2023	3.12.0	COT.002.020	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional	Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [‘4’, ‘1’] then value must be populated
09/21/2023	3.13.0	COT.002.019	UPDATE	Segment key field identifier	Not Applicable	2
08/14/2023	3.12.0	COT.002.018	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	COT.001.014	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	COT.001.012	UPDATE	Coding requirement	1. Value must be in SSN Indicator List (VVL)2. Value must be 1 character3. Mandatory	1. Value must be in SSN Indicator List (VVL)2. Value must be 1 character3. Mandatory4. When populated, value must equal SSN Indicator (ELG.001.012)
08/14/2023	3.12.0	COT.001.010	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. Value of the CC component must be "20"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created (CE)5. Value must be equal to or after associated Start of Time Period (CE)6. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. Value of the CC component must be "20"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created5. Value must be equal to or after associated Start of Time Period6. Mandatory
08/14/2023	3.12.0	COT.001.009	UPDATE	Coding requirement	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created (CE)5. Value must be before associated End of Time Period (CE)6. Mandatory	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created5. Value must be before associated End of Time Period6. Mandatory
08/14/2023	3.12.0	COT.001.008	UPDATE	Coding requirement	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be less than current date5. Value must be equal to or after the value of associated End of Time Period (CE)6. Mandatory	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be less than current date5. Value must be equal to or after the value of associated End of Time Period6. Mandatory
08/28/2023	3.12.0	COT.001.002	UPDATE	Coding requirement	1. Value must be 10 characters or less2. Value must not include the pipe ("\|") symbol3. Mandatory	1. Value must be 10 characters or less2. Value must be in the Data Dictionary Version List (VVL)3. Mandatory
02/16/2023	3.3.0	CLT.003.243	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated	1. Value must be 1 character2. Value must be in [0, 1]
09/21/2023	3.13.0	CLT.003.233	UPDATE	Segment key field identifier	Not Applicable	7
08/21/2023	3.12.0	CLT.003.226	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	CLT.003.212	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID5. When Type of Claim in ['1','3','A','C’] then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in ['01', '02', '03', '04', '05', '06'] (active)
08/14/2023	3.12.0	CLT.003.209	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim (CE) value equals '3, C, W', then value is mandatory and must be provided4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim value equals '3, C, W', then value is mandatory and must be provided4. Conditional
08/09/2023	3.11.0	CLT.003.208	UPDATE	Definition	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/09/2023	3.11.0	CLT.003.205	UPDATE	Definition	The maximum amount displayed at the claim line level as determined by the payer as being "allowable" under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization.	The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity allowed at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/09/2023	3.11.0	CLT.003.204	UPDATE	Definition	The total amount billed for the related Revenue Code. Total amount billed includes both covered and non-covered charges (as defined by UB-04 Billing Manual). For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed to the managed care plan.	The total amount billed for the related Revenue Code. Total amount billed includes both covered and non-covered charges (as defined by UB-04 Billing Manual). For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed to the managed care plan.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/21/2023	3.13.0	CLT.003.191	UPDATE	Segment key field identifier	Not Applicable	5
09/21/2023	3.13.0	CLT.003.190	UPDATE	Segment key field identifier	Not Applicable	4
08/28/2023	3.12.0	CLT.003.189	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional	Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [‘4’, ‘1’] then value must be populated
09/21/2023	3.13.0	CLT.003.188	UPDATE	Segment key field identifier	Not Applicable	2
07/13/2023	3.10.0	CLT.003.187	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less5. When Type of Claim (CLT.002.052) equals 4, D or X (lump sum payment) value must begin with an '&'	1. Mandatory2. Value must be 20 characters or less3. When Type of Claim (CLT.002.052) equals 4, D or X (lump sum payment) value must begin with an '&'
08/14/2023	3.12.0	CLT.003.186	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/10/2023	3.11.0	CLT.002.241	UPDATE	Definition	The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible.	The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability minus previous beneficiary payments that went toward their deductible. Do not subtract out any payments for the given claim that went toward the deductible.
08/10/2023	3.11.0	CLT.002.240	UPDATE	Definition	The total coinsurance amount on a claim that the beneficiary is obligated to pay for covered services. This is the total Medicaid or contract negotiated beneficiary coinsurance liability for covered service on the claim. Do not subtract out any payments made toward the copayment.	The total coinsurance amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary coinsurance liability for covered services on the claim. Do not subtract out any payments made toward the coinsurance.
08/15/2023	3.12.0	CLT.002.174	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. Value must exist in the NPPES data file
08/21/2023	3.12.0	CLT.002.173	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/28/2023	3.12.0	CLT.002.167	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2'3. Value must exist in the NPPES NPI data file4. Conditional
08/23/2023	3.12.0	CLT.002.166	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Third Party Copayment Amount4. Optional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Third Party Copayment Amount4. Situational
08/23/2023	3.12.0	CLT.002.165	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Optional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Situational
08/23/2023	3.12.0	CLT.002.164	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Third Party Coinsurance Amount4. Conditional	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, value must have an associated Third Party Coinsurance Amount 4. Conditional
08/23/2023	3.12.0	CLT.002.163	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Optional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Situational
08/28/2023	3.12.0	CLT.002.160	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	CLT.002.160	UPDATE	Coding requirement	1. Value must be in Copay Waived Indicator List (VVL)2. Value must be 1 character3. Optional	1. Value must be in Copay Waived Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. Situational
09/07/2023	3.12.0	CLT.002.157	UPDATE	Definition	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on the claim. Do not include copayment payments made by a third party/s on behalf of the beneficiary.	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on the claim. Do not include copayment payments made by a third party/ies on behalf of the beneficiary.
09/07/2023	3.12.0	CLT.002.155	UPDATE	Definition	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on the claim. Do not include copayment payments made by a third party/s on behalf of the beneficiary..	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on the claim. Do not include copayment payments made by a third party/ies on behalf of the beneficiary.
09/07/2023	3.12.0	CLT.002.153	UPDATE	Definition	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their coinsurance for the covered services on the claim. Do not include coinsurance payments made by a third party/s on behalf of the beneficiary.	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their coinsurance for the covered services on the claim. Do not include coinsurance payments made by a third party/ies on behalf of the beneficiary.
08/01/2023	3.11.0	CLT.002.151	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Border State Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Border State Indicator List (VVL)4. Conditional
09/21/2023	3.13.0	CLT.002.150	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Split Claim Indicator List (VVL).4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Split Claim Indicator List (VVL).4. Conditional
07/12/2023	3.10.0	CLT.002.144	UPDATE	Definition	The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount.	The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The RA is the detailed explanation of the reason for the payment amount.
08/28/2023	3.12.0	CLT.002.136	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Value must exist in the NPPES NPI data file4. Conditional
08/15/2023	3.12.0	CLT.002.129	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type (CE)2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Conditional
08/28/2023	3.12.0	CLT.002.127	UPDATE	Coding requirement	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Value must be 1 character6. Conditional	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Conditional
08/14/2023	3.12.0	CLT.002.121	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	CLT.002.120	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	CLT.002.119	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	CLT.002.118	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	CLT.002.117	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	CLT.002.116	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	CLT.002.115	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	CLT.002.114	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	CLT.002.113	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	CLT.002.112	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/01/2023	3.11.0	CLT.002.091	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Healthcare Acquired Condition Indicator List (VVL).4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Healthcare Acquired Condition Indicator List (VVL).4. Conditional
08/01/2023	3.11.0	CLT.002.090	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Forced Claim Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Forced Claim Indicator List (VVL)4. Conditional
08/14/2023	3.12.0	CLT.002.087	UPDATE	Coding requirement	1. Value must be a positive integer2. Value must be between 0:9999 (inclusive)3. Value must not include commas or other non-numeric characters4. Value must be equal to the number of claim lines (e.g. Original Claim Line Number (CE) or Adjustment Claim Line Number (CE) instances) reported in the associated claim record being reported5. Value must be 4 characters or less6. Mandatory	1. Value must be a positive integer2. Value must be between 0:9999 (inclusive)3. Value must not include commas or other non-numeric characters4. Value must be equal to the number of claim lines (e.g. Original Claim Line Number or Adjustment Claim Line Number instances) reported in the associated claim record being reported5. Value must be 4 characters or less6. Mandatory
06/14/2023	3.9.0	CLT.002.082	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level.	The field denotes whether the payment amount was determined at the claim header or line/detail level.For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only.For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
08/01/2023	3.11.0	CLT.002.078	UPDATE	Coding requirement	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. Value must be 1 character5. If value equals '1', then Total Medicare Coinsurance amount must not be populated.6. If value equals '0', then Crossover Indicator must equals '0'7. If value equals '1', then Crossover Indicator must equals '1'8. Conditional	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If value equals '1', then Total Medicare Coinsurance amount must not be populated.5. If value equals '0', then Crossover Indicator must equals '0'6. If value equals '1', then Crossover Indicator must equals '1'7. Conditional
06/01/2023	3.8.0	CLT.002.077	UPDATE	Coding requirement	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Conditional	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional
05/31/2023	3.8.0	CLT.002.076	UPDATE	Necessity	Mandatory	Conditional
05/31/2023	3.8.0	CLT.002.076	UPDATE	Coding requirement	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Mandatory	Value must be in Funding Code List (VVL)2. Value must be 1 character3. Conditional
08/01/2023	3.11.0	CLT.002.075	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Fixed Payment Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Fixed Payment Indicator List (VVL)4. Conditional
08/01/2023	3.11.0	CLT.002.071	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Conditional
08/15/2023	3.12.0	CLT.002.069	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than associated Total Billed Amount (CE) - (Total Medicare Coinsurance Amount (CE) + Total Medicare Deductible Amount (CE))4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional
08/09/2023	3.11.0	CLT.002.056	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted.	The field denotes the claims payment system from which the claim was extracted.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.
08/09/2023	3.11.0	CLT.002.052	UPDATE	Definition	A code to indicate what type of payment is covered in this claim.	A code to indicate what type of payment is covered in this claim.For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.
01/05/2023	3.2.0	CLT.002.051	UPDATE	Definition	The date Medicaid paid this claim or adjustment.	The date Medicaid paid this claim or adjustment. For Encounter Records (Type of Claim = 3, C, W), the date the managed care organization paid the provider for the claim or adjustment.
09/21/2023	3.13.0	CLT.002.050	UPDATE	Segment key field identifier	Not Applicable	5
08/14/2023	3.12.0	CLT.002.046	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be less than or equal to associated Adjudication Date (CE) value.4. Value must be greater than or equal to associated Admission Date (CE) value.5. Value must be greater than or equal to associated eligible Date of Birth (CE) value.6. Value must be less than or equal to associated eligible Date of Death (CE) value.7. Conditional8. When populated, Discharge Hour (CLT.002.047) must be populated	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be less than or equal to associated Adjudication Date value.4. Value must be greater than or equal to associated Admission Date value.5. Value must be greater than or equal to associated eligible Date of Birth value.6. Value must be less than or equal to associated eligible Date of Death value.7. Conditional8. When populated, Discharge Hour (CLT.002.047) must be populated
08/14/2023	3.12.0	CLT.002.044	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be less than or equal to associated Discharge Date (CE) value in the claim header.4. Value must be greater than or equal to associated eligible Date of Birth (CE) value.5. Value must be less than or equal to associated eligible Date of Death (CE) value.6. Mandatory7. When associated Type of Claim (CLT.002.052) is not '2','B' or 'V' (capitated payment) value must be before Adjudication Date (CLT.002.050)8. When associated Type of Claim (CLT.002.052) is not '2','B' or 'V' (capitated payment) and Type of Service (CLT.003.211) is not '119, '120', '121', 122' value must be before Adjudication Date (CLT.003.233)	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be less than or equal to associated Discharge Date value in the claim header.4. Value must be greater than or equal to associated eligible Date of Birth value.5. Value must be less than or equal to associated eligible Date of Death value.6. Mandatory7. When associated Type of Claim (CLT.002.052) is not '2','B' or 'V' (capitated payment) value must be before Adjudication Date (CLT.002.050)8. When associated Type of Claim (CLT.002.052) is not '2','B' or 'V' (capitated payment) and Type of Service (CLT.003.211) is not '119, '120', '121', 122' value must be before Adjudication Date (CLT.003.233)
08/15/2023	3.12.0	CLT.002.028	UPDATE	Coding requirement	1. Value must be in Diagnosis Code Flag List(VVL)2. Value must be 1 character	1. Value must be in Diagnosis Code Flag List(VVL)2. Value must be 1 character3. Conditional
08/01/2023	3.11.0	CLT.002.024	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Value must be 1 character5. Conditional6. When value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Conditional5. When value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated
08/28/2023	3.12.0	CLT.002.020	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [‘4’, ‘1’] then value must be populated
09/21/2023	3.13.0	CLT.002.019	UPDATE	Segment key field identifier	Not Applicable	2
08/14/2023	3.12.0	CLT.002.018	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	CLT.001.014	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	CLT.001.012	UPDATE	Coding requirement	1. Value must be in SSN Indicator List (VVL)2. Value must be 1 character3. Mandatory	1. Value must be in SSN Indicator List (VVL)2. Value must be 1 character3. Mandatory4. When populated, value must equal SSN Indicator (ELG.001.012)
08/14/2023	3.12.0	CLT.001.010	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. Value of the CC component must be "20"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created (CE)5. Value must be equal to or after associated Start of Time Period (CE)6. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. Value of the CC component must be "20"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created5. Value must be equal to or after associated Start of Time Period6. Mandatory
08/14/2023	3.12.0	CLT.001.009	UPDATE	Coding requirement	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created (CE)5. Value must be before associated End of Time Period (CE)6. Mandatory	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created5. Value must be before associated End of Time Period6. Mandatory
08/14/2023	3.12.0	CLT.001.008	UPDATE	Coding requirement	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be less than current date5. Value must be equal to or after the value of associated End of Time Period (CE)6. Mandatory	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be less than current date5. Value must be equal to or after the value of associated End of Time Period6. Mandatory
08/28/2023	3.12.0	CLT.001.002	UPDATE	Coding requirement	1. Value must be 10 characters or less2. Value must not include the pipe ("\|") symbol3. Mandatory	Value must be 10 characters or less2. Value must be in the Data Dictionary Version List (VVL)3. Mandatory
02/16/2023	3.3.0	CIP.003.296	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated	1. Value must be 1 character2. Value must be in [0, 1]
09/21/2023	3.13.0	CIP.003.286	UPDATE	Segment key field identifier	Not Applicable	7
08/21/2023	3.12.0	CIP.003.273	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/16/2023	3.12.0	CIP.003.269	UPDATE	Coding requirement	1. Value must be in CMS 64 Category for Federal Reimbursement List (VVL)2. Value must be 2 characters3. (Federal Funding under Title XXI) if value equals '02', then the eligible's CHIP Code (ELG.003.054) must be in ['2', '3']4. (Federal Funding under Title XIX) if value equals '01' then the eligible's CHIP Code (ELG.003.054) must be '1'5. Conditional6. If Type of Claim is in ['1','2','5','A','B','E','U','V','Y'] and the Total Medicaid Paid Amount is populated on the corresponding claim header, then value must be reported.7. If Type of Claim is in ['4','D'] and the Service Tracking Payment Amount on the relevant record is populated, then value must be reported.	Value must be in CMS 64 Category for Federal Reimbursement List (VVL)2. Value must be 2 characters3. (Federal Funding under Title XXI) if value equals '02', then the eligible's CHIP Code (ELG.003.054) must be in ['2', '3']4. (Federal Funding under Title XIX) if value equals '01' then the eligible's CHIP Code (ELG.003.054) must be '1'5. Conditional6. If Type of Claim is in ['1','2','5','A','B','E','U','V','Y'] and the Total Medicaid Paid Amount is populated on the corresponding claim header, then value must be reported.7. If Type of Claim is in ['4','D'] and the Service Tracking Payment Amount on the relevant record is populated, then value must be reported.8. When Type of Claim is in [‘1’, ‘A’], value must be populated
09/21/2023	3.13.0	CIP.003.265	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. Value must exist in the NPPES NPI data file
09/21/2023	3.13.0	CIP.003.260	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID5. When Type of Claim in ['1','3','A','C’] then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in ['01', '02', '03', '04', '05', '06'] (active)
09/01/2023	3.12.0	CIP.003.255	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim (CE) value equals '3, C, W', then value is mandatory and must be provided4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim value equals '3, C, W', then value is mandatory and must be provided4. Conditional
08/09/2023	3.11.0	CIP.003.254	UPDATE	Definition	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/09/2023	3.11.0	CIP.003.252	UPDATE	Definition	The maximum amount displayed at the claim line level as determined by the payer as being "allowable" under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization.	The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity allowed at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/09/2023	3.11.0	CIP.003.251	UPDATE	Definition	The total amount billed for the related Revenue Code. Total amount billed includes both covered and non-covered charges (as defined by UB-04 Billing Manual). For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed to the managed care plan.	The total amount billed for the related Revenue Code. Total amount billed includes both covered and non-covered charges (as defined by UB-04 Billing Manual). For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed to the managed care plan.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/21/2023	3.13.0	CIP.003.238	UPDATE	Segment key field identifier	Not Applicable	5
09/21/2023	3.13.0	CIP.003.237	UPDATE	Segment key field identifier	Not Applicable	4
08/28/2023	3.12.0	CIP.003.236	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional	Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [‘4’, ‘1’] then value must be populated
09/21/2023	3.13.0	CIP.003.235	UPDATE	Segment key field identifier	Not Applicable	2
07/13/2023	3.10.0	CIP.003.234	UPDATE	Coding requirement	1. Mandatory2. For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN3. For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN4. Value must be 20 characters or less5. When Type of Claim (CIP.002.100) = 4, D or X (lump sum payment) value must begin with an '&'	1. Mandatory2. Value must be 20 characters or less3. When Type of Claim (CIP.002.100) = 4, D or X (lump sum payment) value must begin with an '&'
08/14/2023	3.12.0	CIP.003.233	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/10/2023	3.11.0	CIP.002.294	UPDATE	Definition	The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible.	The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability minus previous beneficiary payments that went toward their deductible. Do not subtract out any payments for the given claim that went toward the deductible.
08/10/2023	3.11.0	CIP.002.293	UPDATE	Definition	The total coinsurance amount on a claim that the beneficiary is obligated to pay for covered services. This is the total Medicaid or contract negotiated beneficiary coinsurance liability for covered service on the claim. Do not subtract out any payments made toward the copayment.	The total coinsurance amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary coinsurance liability for covered services on the claim. Do not subtract out any payments made toward the coinsurance.
08/21/2023	3.12.0	CIP.002.229	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
08/28/2023	3.12.0	CIP.002.221	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2' 3. Value must exist in the NPPES NPI data file4. Conditional
08/28/2023	3.12.0	CIP.002.220	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional4. When Type of Claim is in ['4', 'D', 'X'], value must not be populated
08/23/2023	3.12.0	CIP.002.219	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Third Party Copayment Amount4. Optional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Third Party Copayment Amount4. Situational
08/23/2023	3.12.0	CIP.002.218	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Optional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Situational
08/23/2023	3.12.0	CIP.002.217	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Third Party Coinsurance Amount4. Conditional	Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. When populated, value must have an associated Third Party Coinsurance Amount 4. Conditional
08/23/2023	3.12.0	CIP.002.216	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Optional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Situational
08/28/2023	3.12.0	CIP.002.213	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	CIP.002.213	UPDATE	Coding requirement	1. Value must be in Copay Waived Indicator List (VVL)2. Value must be 1 character3. Optional	1. Value must be in Copay Waived Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. Situational
09/07/2023	3.12.0	CIP.002.210	UPDATE	Definition	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their deductible for the covered services on the claim. Do not include deductible payments made by a third party/s on behalf of the beneficiary.	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their deductible for the covered services on the claim. Do not include deductible payments made by a third party/ies on behalf of the beneficiary.
09/07/2023	3.12.0	CIP.002.208	UPDATE	Definition	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on the claim. Do not include copayment payments made by a third party/s on behalf of the beneficiary.	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on the claim. Do not include copayment payments made by a third party/ies on behalf of the beneficiary.
09/07/2023	3.12.0	CIP.002.206	UPDATE	Definition	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their coinsurance for the covered services on the claim. Do not include coinsurance payments made by a third party/s on behalf of the beneficiary.	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their coinsurance for the covered services on the claim. Do not include coinsurance payments made by a third party/ies on behalf of the beneficiary.
08/01/2023	3.11.0	CIP.002.204	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Border State Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Border State Indicator List (VVL)4. Conditional
09/21/2023	3.13.0	CIP.002.203	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Split Claim Indicator List (VVL).4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Split Claim Indicator List (VVL).4. Conditional
07/12/2023	3.10.0	CIP.002.202	UPDATE	Definition	The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount.	The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The RA is the detailed explanation of the reason for the payment amount.
07/12/2023	3.10.0	CIP.002.194	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must not be populated, if Outlier Code (CIP.002.197) equals '00' or '09'4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be populated, if Outlier Code (CIP.002.197) equals '00' or '09'4. Conditional
08/28/2023	3.12.0	CIP.002.190	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Value must exist in the NPPES NPI data file4. Conditional
08/15/2023	3.12.0	CIP.002.184	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Conditional3. Value must have an associated Provider Identifier Type equal to '2'	1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to '2'4. Value must exist in the NPPES NPI File
08/15/2023	3.12.0	CIP.002.178	UPDATE	Coding requirement	1. Value must be associated with a populated Waiver Type (CE)2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Conditional	1. Value must be associated with a populated Waiver Type2. Value must be 20 characters or less3. (1115 demonstration waivers) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20, 32, 33]5. Conditional
08/28/2023	3.12.0	CIP.002.176	UPDATE	Coding requirement	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Value must be 1 character6. Conditional	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Conditional
08/14/2023	3.12.0	CIP.002.169	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	CIP.002.168	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	CIP.002.166	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	CIP.002.165	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	CIP.002.164	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	CIP.002.163	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	CIP.002.162	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	CIP.002.161	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/14/2023	3.12.0	CIP.002.160	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code (CE)4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Must have an associated Occurrence Code4. Must be greater than or equal to Occurrence Code Effective Date5. Conditional
08/01/2023	3.11.0	CIP.002.139	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Healthcare Acquired Condition Indicator List (VVL).4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Healthcare Acquired Condition Indicator List (VVL).4. Conditional
08/01/2023	3.11.0	CIP.002.138	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Forced Claim Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Forced Claim Indicator List (VVL)4. Conditional
08/14/2023	3.12.0	CIP.002.137	UPDATE	Coding requirement	1. Value must be a positive integer2. Value must be between 0:9999 (inclusive)3. Value must not include commas or other non-numeric characters4. Value must be equal to the number of claim lines (e.g. Original Claim Line Number (CE) or Adjustment Claim Line Number (CE) instances) reported in the associated claim record being reported5. Value must be 4 characters or less6. Mandatory	1. Value must be a positive integer2. Value must be between 0:9999 (inclusive)3. Value must not include commas or other non-numeric characters4. Value must be equal to the number of claim lines (e.g. Original Claim Line Number or Adjustment Claim Line Number instances) reported in the associated claim record being reported5. Value must be 4 characters or less6. Mandatory
06/14/2023	3.9.0	CIP.002.132	UPDATE	Definition	The field denotes whether the payment amount was determined at the claim header or line/detail level.	The field denotes whether the payment amount was determined at the claim header or line/detail level.For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only.For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
08/01/2023	3.11.0	CIP.002.128	UPDATE	Coding requirement	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. Value must be 1 character5. If value equals '1', then Total Medicare Coinsurance amount must not be populated.6. If value equals '0', then Crossover Indicator must equals '0'7. If value equals '1', then Crossover Indicator must equals '1'8. Conditional	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If value equals '1', then Total Medicare Coinsurance amount must not be populated.5. If value equals '0', then Crossover Indicator must equals '0'6. If value equals '1', then Crossover Indicator must equals '1'7. Conditional
06/01/2023	3.8.0	CIP.002.127	UPDATE	Coding requirement	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Conditional	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional
05/31/2023	3.8.0	CIP.002.126	UPDATE	Necessity	Mandatory	Conditional
05/31/2023	3.8.0	CIP.002.126	UPDATE	Coding requirement	1. Value must be in Funding Code List (VVL)2. Value must be 1 character3. Mandatory	Value must be in Funding Code List (VVL)2. Value must be 1 character3. Conditional
08/01/2023	3.11.0	CIP.002.125	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Fixed Payment Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Fixed Payment Indicator List (VVL)4. Conditional
08/01/2023	3.11.0	CIP.002.121	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Conditional
08/15/2023	3.12.0	CIP.002.118	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than associated Total Billed Amount (CE) - (Total Medicare Coinsurance Amount (CE) + Total Medicare Deductible Amount (CE))4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional
08/09/2023	3.11.0	CIP.002.104	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted.	The field denotes the claims payment system from which the claim was extracted.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.
08/09/2023	3.11.0	CIP.002.100	UPDATE	Definition	A code to indicate what type of payment is covered in this claim.	A code to indicate what type of payment is covered in this claim.For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.
01/05/2023	3.2.0	CIP.002.099	UPDATE	Definition	The date Medicaid paid this claim or adjustment.	The date Medicaid paid this claim or adjustment. For Encounter Records (Type of Claim = 3, C, W), the date the managed care organization paid the provider for the claim or adjustment.
09/21/2023	3.13.0	CIP.002.098	UPDATE	Segment key field identifier	Not Applicable	5
09/21/2023	3.13.0	CIP.002.069	UPDATE	Medicaid valid value info	Values are generated by combining two types of information: Position 1-2, State/Group generating DRG: If state specific system, fill with two digit US postal code representation for state.If CMS Grouper, fill with 'HG'.If any other system, fill with 'XX'.Position 3-4, fill with the number that represents the DRG version used (01-98).For example, 'HG15' would represent CMS Grouper version 15. If version is unknown, fill with '99'.
09/21/2023	3.13.0	CIP.002.068	UPDATE	Medicaid valid value info	If the first two characters of the diagnosis related group indicator is 'HG' which indicates a CMS DRG Group code was assigned, then the value for the diagnosis related group must be from the following list of valid values.
08/15/2023	3.12.0	CIP.002.031	UPDATE	Coding requirement	1. Value must be in Diagnosis Code Flag List(VVL)2. Value must be 1 character	1. Value must be in Diagnosis Code Flag List(VVL)2. Value must be 1 character3. Conditional
08/01/2023	3.11.0	CIP.002.025	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Value must be 1 character5. Conditional6. When value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Conditional5. When value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated
08/28/2023	3.12.0	CIP.002.020	UPDATE	Coding requirement	1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional	Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value is 0, then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [‘4’, ‘1’] then value must be populated
09/21/2023	3.13.0	CIP.002.019	UPDATE	Segment key field identifier	Not Applicable	2
08/14/2023	3.12.0	CIP.002.018	UPDATE	Coding requirement	1. Value must be unique within record segment over all records associated with a given Record ID (CE)2. Value must be 11 digits or less3. Mandatory	1. Value must be unique within record segment over all records associated with a given Record ID2. Value must be 11 digits or less3. Mandatory
08/21/2023	3.12.0	CIP.001.014	UPDATE	Coding requirement	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Optional	1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational
09/21/2023	3.13.0	CIP.001.012	UPDATE	Coding requirement	1. Value must be in SSN Indicator List (VVL)2. Value must be 1 character3. Mandatory	1. Value must be in SSN Indicator List (VVL)2. Value must be 1 character3. Mandatory4. When populated, value must equal SSN Indicator (ELG.001.012)
08/14/2023	3.12.0	CIP.001.010	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. Value of the CC component must be "20"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created (CE)5. Value must be equal to or after associated Start of Time Period (CE)6. Mandatory	1. Value must be 8 characters in the form "CCYYMMDD"2. Value of the CC component must be "20"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created5. Value must be equal to or after associated Start of Time Period6. Mandatory
08/14/2023	3.12.0	CIP.001.009	UPDATE	Coding requirement	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created (CE)5. Value must be before associated End of Time Period (CE)6. Mandatory	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be equal to or earlier than associated Date File Created5. Value must be before associated End of Time Period6. Mandatory
08/14/2023	3.12.0	CIP.001.008	UPDATE	Coding requirement	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be less than current date5. Value must be equal to or after the value of associated End of Time Period (CE)6. Mandatory	1. Value of the CC component must be "20"2. Value must be 8 characters in the form "CCYYMMDD"3. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)4. Value must be less than current date5. Value must be equal to or after the value of associated End of Time Period6. Mandatory
08/28/2023	3.12.0	CIP.001.002	UPDATE	Coding requirement	1. Value must be 10 characters or less2. Value must not include the pipe ("\|") symbol3. Mandatory	1. Value must be 10 characters or less2. Value must be in the Data Dictionary Version List (VVL)3. Mandatory
12/22/2022	3.1.0	Data Elements	UPDATE	Description	Specifications for all the data elements including valid values and related rules and measures.	Specifications for all the data elements including valid values, related rules, and measures.
06/02/2023	3.8.0	EL-1-031-38	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is OtherOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE-CODE equals "018" on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is OtherOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE equals "018" on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.
12/09/2022	3.0.6	EL-1-031-38	ADD	N/A		Created
06/02/2023	3.8.0	EL-1-030-37	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is Native Hawaiian or Other Pacific IslanderOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE-CODE = (“012,” “013,” “014,” “015,” or “016,”) on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is Native Hawaiian or Other Pacific IslanderOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE = (“012,” “013,” “014,” “015,” or “016,”) on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.
12/09/2022	3.0.6	EL-1-030-37	ADD	N/A		Created
06/02/2023	3.8.0	EL-1-029-36	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is AsianOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE-CODE = (“004,” “005,” “006,” “007,” “008,” “009,” “010,” or “011,”) on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is AsianOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE = (“004,” “005,” “006,” “007,” “008,” “009,” “010,” or “011,”) on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.
12/09/2022	3.0.6	EL-1-029-36	ADD	N/A		Created
06/02/2023	3.8.0	EL-1-028-35	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is American Indian or Alaska NativeOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE-CODE equals "003" on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is American Indian or Alaska NativeOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE equals "003" on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.
12/09/2022	3.0.6	EL-1-028-35	ADD	N/A		Created
06/02/2023	3.8.0	EL-1-027-34	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is Black or African AmericanOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE-CODE equals "002" on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is Black or African AmericanOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE equals "002" on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.
12/09/2022	3.0.6	EL-1-027-34	ADD	N/A		Created
06/02/2023	3.8.0	EL-1-026-33	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is WhiteOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE-CODE equals "001" on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Race is WhiteOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE equals "001" on any record segmentSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.
12/09/2022	3.0.6	EL-1-026-33	ADD	N/A		Created
09/06/2023	3.12.0	MCR-65-012-12	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	MCR-65-012-12	UPDATE	Category	N/A	Program participation
09/06/2023	3.12.0	MCR-65-012-12	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	MCR-65-012-12	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	MCR-65-012-12	UPDATE	Ta min		0
09/06/2023	3.12.0	MCR-65-012-12	UPDATE	Ta max		0.1
09/06/2023	3.12.0	MCR-65-012-12	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	MCR-65-012-12	UPDATE	Threshold maximum	TBD	0.1
12/09/2022	3.0.6	MCR-65-012-12	ADD	N/A		Created
09/06/2023	3.12.0	MCR-65-011-11	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	MCR-65-011-11	UPDATE	Category	N/A	Program participation
09/06/2023	3.12.0	MCR-65-011-11	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	MCR-65-011-11	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	MCR-65-011-11	UPDATE	Ta min		0
09/06/2023	3.12.0	MCR-65-011-11	UPDATE	Ta max		0.1
09/06/2023	3.12.0	MCR-65-011-11	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	MCR-65-011-11	UPDATE	Threshold maximum	TBD	0.1
12/09/2022	3.0.6	MCR-65-011-11	ADD	N/A		Created
09/06/2023	3.12.0	MCR-65-010-10	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	MCR-65-010-10	UPDATE	Category	N/A	Program participation
09/06/2023	3.12.0	MCR-65-010-10	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	MCR-65-010-10	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	MCR-65-010-10	UPDATE	Ta min		0
09/06/2023	3.12.0	MCR-65-010-10	UPDATE	Ta max		0.1
09/06/2023	3.12.0	MCR-65-010-10	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	MCR-65-010-10	UPDATE	Threshold maximum	TBD	0.1
12/09/2022	3.0.6	MCR-65-010-10	ADD	N/A		Created
09/06/2023	3.12.0	MCR-65-009-9	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	MCR-65-009-9	UPDATE	Category	N/A	Program participation
09/06/2023	3.12.0	MCR-65-009-9	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	MCR-65-009-9	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	MCR-65-009-9	UPDATE	Ta min		0
09/06/2023	3.12.0	MCR-65-009-9	UPDATE	Ta max		0.1
09/06/2023	3.12.0	MCR-65-009-9	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	MCR-65-009-9	UPDATE	Threshold maximum	TBD	0.1
12/09/2022	3.0.6	MCR-65-009-9	ADD	N/A		Created
09/06/2023	3.12.0	MCR-65-008-8	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	MCR-65-008-8	UPDATE	Category	N/A	Program participation
09/06/2023	3.12.0	MCR-65-008-8	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	MCR-65-008-8	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	MCR-65-008-8	UPDATE	Ta min		0
09/06/2023	3.12.0	MCR-65-008-8	UPDATE	Ta max		0.1
09/06/2023	3.12.0	MCR-65-008-8	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	MCR-65-008-8	UPDATE	Threshold maximum	TBD	0.1
12/09/2022	3.0.6	MCR-65-008-8	ADD	N/A		Created
09/06/2023	3.12.0	MCR-65-007-7	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	MCR-65-007-7	UPDATE	Category	N/A	Program participation
09/06/2023	3.12.0	MCR-65-007-7	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	MCR-65-007-7	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	MCR-65-007-7	UPDATE	Ta min		0
09/06/2023	3.12.0	MCR-65-007-7	UPDATE	Ta max		0.1
09/06/2023	3.12.0	MCR-65-007-7	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	MCR-65-007-7	UPDATE	Threshold maximum	TBD	0.1
12/09/2022	3.0.6	MCR-65-007-7	ADD	N/A		Created
09/06/2023	3.12.0	MCR-65-006-6	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	MCR-65-006-6	UPDATE	Category	N/A	Program participation
09/06/2023	3.12.0	MCR-65-006-6	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	MCR-65-006-6	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	MCR-65-006-6	UPDATE	Ta min		0
09/06/2023	3.12.0	MCR-65-006-6	UPDATE	Ta max		0.1
09/06/2023	3.12.0	MCR-65-006-6	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	MCR-65-006-6	UPDATE	Threshold maximum	TBD	0.1
12/09/2022	3.0.6	MCR-65-006-6	ADD	N/A		Created
09/06/2023	3.12.0	MCR-65-005-5	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	MCR-65-005-5	UPDATE	Category	N/A	Program participation
09/06/2023	3.12.0	MCR-65-005-5	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	MCR-65-005-5	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	MCR-65-005-5	UPDATE	Ta min		0
09/06/2023	3.12.0	MCR-65-005-5	UPDATE	Ta max		0.1
09/06/2023	3.12.0	MCR-65-005-5	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	MCR-65-005-5	UPDATE	Threshold maximum	TBD	0.1
12/09/2022	3.0.6	MCR-65-005-5	ADD	N/A		Created
09/06/2023	3.12.0	MCR-65-004-4	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	MCR-65-004-4	UPDATE	Category	N/A	Program participation
09/06/2023	3.12.0	MCR-65-004-4	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	MCR-65-004-4	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	MCR-65-004-4	UPDATE	Ta min		0
09/06/2023	3.12.0	MCR-65-004-4	UPDATE	Ta max		0.1
09/06/2023	3.12.0	MCR-65-004-4	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	MCR-65-004-4	UPDATE	Threshold maximum	TBD	0.1
12/09/2022	3.0.6	MCR-65-004-4	ADD	N/A		Created
09/06/2023	3.12.0	MCR-65-003-3	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	MCR-65-003-3	UPDATE	Category	N/A	Program participation
09/06/2023	3.12.0	MCR-65-003-3	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	MCR-65-003-3	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	MCR-65-003-3	UPDATE	Ta min		0
09/06/2023	3.12.0	MCR-65-003-3	UPDATE	Ta max		0.1
09/06/2023	3.12.0	MCR-65-003-3	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	MCR-65-003-3	UPDATE	Threshold maximum	TBD	0.1
12/09/2022	3.0.6	MCR-65-003-3	ADD	N/A		Created
09/06/2023	3.12.0	MCR-65-002-2	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	MCR-65-002-2	UPDATE	Category	N/A	Program participation
09/06/2023	3.12.0	MCR-65-002-2	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	MCR-65-002-2	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	MCR-65-002-2	UPDATE	Ta min		0
09/06/2023	3.12.0	MCR-65-002-2	UPDATE	Ta max		0.1
09/06/2023	3.12.0	MCR-65-002-2	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	MCR-65-002-2	UPDATE	Threshold maximum	TBD	0.1
12/09/2022	3.0.6	MCR-65-002-2	ADD	N/A		Created
09/06/2023	3.12.0	MCR-65-001-1	UPDATE	Priority	N/A	High
09/06/2023	3.12.0	MCR-65-001-1	UPDATE	Category	N/A	Program participation
09/06/2023	3.12.0	MCR-65-001-1	UPDATE	For ta comprehensive	No	TA- Inferential
09/06/2023	3.12.0	MCR-65-001-1	UPDATE	For ta inferential	No	Yes
09/06/2023	3.12.0	MCR-65-001-1	UPDATE	Ta min		0
09/06/2023	3.12.0	MCR-65-001-1	UPDATE	Ta max		0.1
09/06/2023	3.12.0	MCR-65-001-1	UPDATE	Threshold minimum	TBD	0
09/06/2023	3.12.0	MCR-65-001-1	UPDATE	Threshold maximum	TBD	0.1
12/09/2022	3.0.6	MCR-65-001-1	ADD	N/A		Created
01/27/2023	3.2.0	PRV-6-004-4	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE <= last day of the reporting month3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is an individualOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "03"STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Code is missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population using segment by keeping records that meet the following criteria:1. PROVIDER-CLASSIFICATION-CODE is missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is an individualOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "03"STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Code is missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population using segment by keeping records that meet the following criteria:1. PROVIDER-CLASSIFICATION-CODE is missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3
01/27/2023	3.2.0	PRV-6-003-3	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE <= last day of the reporting month3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is a facility or groupOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "01" or "02"STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Code is missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1. PROVIDER-CLASSIFICATION-CODE is missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month or missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is a facility or groupOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "01" or "02"STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Code is missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1. PROVIDER-CLASSIFICATION-CODE is missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3
01/27/2023	3.2.0	PRV-6-002-2	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE <= last day of the reporting month3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is an individualOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "03" STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Lookup Designation is "Facility or Group" or missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1a. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Provider Classification lookup tableAND1b. Provider Classification Lookup Designation = “Facility” or "Group"OR2. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE do not equal to values in Provider Classification lookup tableOR3. PROV-IDENTIFIER-TYPE is missingOR4. PROVIDER-CLASSIFICATION-CODE is missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month or missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is an individualOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "03" STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Lookup Designation is "Facility or Group" or missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1a. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Provider Classification lookup tableAND1b. Provider Classification Lookup Designation = “Facility” or "Group"OR2. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE do not equal to values in Provider Classification lookup tableOR3. PROV-IDENTIFIER-TYPE is missingOR4. PROVIDER-CLASSIFICATION-CODE is missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3
01/27/2023	3.2.0	PRV-6-001-1	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE <= last day of the reporting month3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is a facility or groupOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "01" or "02" STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Lookup Designation is "Individual" or missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1a. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Provider Classification lookup tableAND1b. Provider Classification Lookup Designation = “Individual”OR2. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE do not equal to values in Provider Classification lookup tableOR3. PROV-IDENTIFIER-TYPE is missingOR4. PROVIDER-CLASSIFICATION-CODE is missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month or missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is a facility or groupOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "01" or "02" STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Lookup Designation is "Individual" or missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1a. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Provider Classification lookup tableAND1b. Provider Classification Lookup Designation = “Individual”OR2. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE do not equal to values in Provider Classification lookup tableOR3. PROV-IDENTIFIER-TYPE is missingOR4. PROVIDER-CLASSIFICATION-CODE is missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3
04/21/2023	3.6.0	EL-19-001-1	UPDATE	Specification	STEP 1: Enrolled any day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= first day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Enrolled any day of prior DQ report monthDefine the prior eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the prior DQ report month 2. ENROLLMENT-END-DATE >= first day of the prior DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Enrolled in prior month but not current monthKeep all MSIS IDs from STEP 2 that are NOT in STEP 1STEP 4: Eligibility determinants any day of prior DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the prior DQ report month3. ELIGIBILITY-DETERMINANT-END-DATE >= first day of the prior DQ report month OR missing*Note: If multiple segments meet the criteria for one MSIS ID, keep latest one (sort by max end date, max effective date, min record byte offset)STEP 5: Valid, known eligibility change reasonOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with: 1. ELIGIBILITY-CHANGE-REASON = (“01”,“02”,“03”,“04”,“05”, “06”,”07”,“08”,“09”,“10”,“11”,“12”, “13”,“14”,“15”,“16”,“17”, “18”,“19”, or “20”)STEP 6: Missing, invalid, unknown, or other eligibility change reasonKeep all MSIS IDs from STEP 3 that are NOT in STEP 5STEP 7: Calculate percentageDivide the unique count of MSIS IDs from STEP 6 by the unique count of MSIS IDs from STEP 3	STEP 1: Enrolled any day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= first day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Enrolled any day of prior DQ report monthDefine the prior eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the prior DQ report month 2. ENROLLMENT-END-DATE >= first day of the prior DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Enrolled in prior month but not current monthKeep all MSIS IDs from STEP 2 that are NOT in STEP 1STEP 4: Eligibility determinants any day of prior DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the prior DQ report month3. ELIGIBILITY-DETERMINANT-END-DATE >= first day of the prior DQ report month OR missing*Note: If multiple segments meet the criteria for one MSIS ID, keep latest one (sort by max end date, max effective date, min record byte offset)STEP 5: Valid, known eligibility change reasonOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with: 1. ELIGIBILITY-CHANGE-REASON = (“01”,“02”,“04”, “06”,”07”,“08”,“09”,“10”,“11”,“12”, “13”,“14”,“15”,“16”,“17”, “18”,“19”, “20”, “23”, “24”, “25”, “26”, “27”, “28”, “29”, “30”, or “31”)STEP 6: Missing, invalid, unknown, or other eligibility change reasonKeep all MSIS IDs from STEP 3 that are NOT in STEP 5STEP 7: Calculate percentageDivide the unique count of MSIS IDs from STEP 6 by the unique count of MSIS IDs from STEP 3
12/22/2022	3.1.0	Data Quality Measures	UPDATE	Version text		3.4.0
03/24/2023	3.5.0	CRX - CLAIM PRESCRIPTION	UPDATE	Title	CRX - CLAIM PERSCRIPTION	CRX - CLAIM PRESCRIPTION
03/24/2023	3.5.0	CRX - CLAIM PRESCRIPTION	UPDATE	File name	CRX - CLAIM PERSCRIPTION	CRX - CLAIM PRESCRIPTION
04/21/2023	3.6.0	RULE-7645	UPDATE	File type	CRX	Multiple Files
04/21/2023	3.6.0	RULE-7644	UPDATE	File type	COT	Multiple Files
04/21/2023	3.6.0	RULE-7643	UPDATE	File type	CLT	Multiple Files
04/21/2023	3.6.0	RULE-7642	UPDATE	File type	CIP	Multiple Files
09/06/2023	3.12.0	RULE-7559	UPDATE	Priority	High	N/A
09/06/2023	3.12.0	RULE-7559	UPDATE	Category	Beneficiary demographics	N/A
09/06/2023	3.12.0	RULE-7559	UPDATE	For ta comprehensive	TA- Inferential	No
09/06/2023	3.12.0	RULE-7559	UPDATE	For ta inferential	Yes	No
09/06/2023	3.12.0	RULE-7559	UPDATE	Ta min	0
09/06/2023	3.12.0	RULE-7559	UPDATE	Ta max	0.001
06/02/2023	3.8.0	EL-1-014-32	UPDATE	Priority	N/A	Medium
06/02/2023	3.8.0	EL-1-014-32	UPDATE	Category	N/A	Beneficiary eligibility
06/02/2023	3.8.0	EL-1-014-32	UPDATE	For ta comprehensive	No	TA- Inferential
06/02/2023	3.8.0	EL-1-014-32	UPDATE	For ta inferential	No	Yes
06/02/2023	3.8.0	EL-1-014-32	UPDATE	Ta min		0
06/02/2023	3.8.0	EL-1-014-32	UPDATE	Ta max		0.5
06/02/2023	3.8.0	EL-1-014-32	UPDATE	Threshold minimum	TBD	0
06/02/2023	3.8.0	EL-1-014-32	UPDATE	Threshold maximum	TBD	0.5
04/21/2023	3.6.0	MCR-64-004_1-8	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: No Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing on all lines2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers from STEP 2	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: No Medicare AmountsOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing on all lines2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 5: Calculate percentageDivide the count of claim headers from STEP 4 by the count of claim headers from STEP 3.
04/21/2023	3.6.0	MCR-64-003_1-7	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: No Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing on all lines2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers from STEP 2	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: No Medicare AmountsOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing on all lines2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 5: Calculate percentageDivide the count of claim headers from STEP 4 by the count of claim headers from STEP 3.
04/21/2023	3.6.0	MCR-64-002_1-6	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: No Medicare Amounts Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers from STEP 2	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: No Medicare Amounts Of the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 5: Calculate percentageDivide the count of claim headers from STEP 4 by the count of claim headers from STEP 3.
04/21/2023	3.6.0	MCR-64-001_1-5	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: No Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers from STEP 2	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: No Medicare AmountsOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 5: Calculate percentageDivide the count of claim headers from STEP 4 by the count of claim headers from STEP 3.
04/21/2023	3.6.0	FFS-54-004_1-8	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	FFS-54-004_1-8	UPDATE	Category	Expenditures	N/A
04/21/2023	3.6.0	FFS-54-004_1-8	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	FFS-54-004_1-8	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	FFS-54-004_1-8	UPDATE	Ta min	0
04/21/2023	3.6.0	FFS-54-004_1-8	UPDATE	Ta max	0.1
04/21/2023	3.6.0	FFS-54-004_1-8	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: non-void, crossover, paid RX claims where Medicare paid amount, total Medicare coinsurance amount, and total Medicare deductible amount are equal to 0 or are missing	N/A
04/21/2023	3.6.0	FFS-54-004_1-8	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: No Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing on all lines2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers from STEP 2	N/A
04/21/2023	3.6.0	FFS-54-003_1-7	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	FFS-54-003_1-7	UPDATE	Category	Expenditures	N/A
04/21/2023	3.6.0	FFS-54-003_1-7	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	FFS-54-003_1-7	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	FFS-54-003_1-7	UPDATE	Ta min	0
04/21/2023	3.6.0	FFS-54-003_1-7	UPDATE	Ta max	0.1
04/21/2023	3.6.0	FFS-54-003_1-7	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: non-void, crossover, paid OT claims where Medicare paid amount, total Medicare coinsurance amount, and total Medicare deductible amount are equal to 0 or are missing	N/A
04/21/2023	3.6.0	FFS-54-003_1-7	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: No Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing on all lines2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers from STEP 2	N/A
04/21/2023	3.6.0	FFS-54-002_1-6	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	FFS-54-002_1-6	UPDATE	Category	Expenditures	N/A
04/21/2023	3.6.0	FFS-54-002_1-6	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	FFS-54-002_1-6	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	FFS-54-002_1-6	UPDATE	Ta min	0
04/21/2023	3.6.0	FFS-54-002_1-6	UPDATE	Ta max	0.1
04/21/2023	3.6.0	FFS-54-002_1-6	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: non-void, crossover, paid LT claims where Medicare paid amount, total Medicare coinsurance amount, and total Medicare deductible amount are equal to 0 or are missing	N/A
04/21/2023	3.6.0	FFS-54-002_1-6	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: No Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers from STEP 2	N/A
04/21/2023	3.6.0	FFS-54-001_1-5	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	FFS-54-001_1-5	UPDATE	Category	Expenditures	N/A
04/21/2023	3.6.0	FFS-54-001_1-5	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	FFS-54-001_1-5	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	FFS-54-001_1-5	UPDATE	Ta min	0
04/21/2023	3.6.0	FFS-54-001_1-5	UPDATE	Ta max	0.1
04/21/2023	3.6.0	FFS-54-001_1-5	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: non-void, crossover, paid IP claims where Medicare paid amount, total Medicare coinsurance amount, and total Medicare deductible amount are equal to 0 or are missing	N/A
04/21/2023	3.6.0	FFS-54-001_1-5	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: No Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers from STEP 2	N/A
03/10/2023	3.4.0	EL-3-019_1-34	UPDATE	Annotation	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "73", "74", or "75" for states NOT expected to report these values according to MBES enrollment data	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "73", "74", or "75" for states NOT expected to report these values according to public MBES enrollment data on Medicaid.gov
03/10/2023	3.4.0	EL-3-019_1-34	UPDATE	Specification	STEP 1: Measure applies to submitting state1a. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are NO enrollees in any "Not Newly Eligible" category in the MBES enrollment data, proceed to STEP 2.ELSE1b. If submitting state is expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are enrollees in any "Not Newly Eligible" category in the MBES enrollment data, the final measure statistic will be displayed as "N/A".STEP 2: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 2, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 4: MSIS IDs with eligibility group 73, 74, or 75Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "73", "74", or "75"STEP 5: Calculate percentageDivide the count from STEP 4 by the count from STEP 2	STEP 1: Measure applies to submitting state1a. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are NO enrollees in any "Not Newly Eligible" category in the MBES enrollment data, proceed to STEP 2.ELSE1b. If submitting state is expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are enrollees in any "Not Newly Eligible" category in the public MBES enrollment data on Medicaid.gov, the final measure statistic will be displayed as "N/A".STEP 2: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 2, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 4: MSIS IDs with eligibility group 73, 74, or 75Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "73", "74", or "75"STEP 5: Calculate percentageDivide the count from STEP 4 by the count from STEP 2
03/10/2023	3.4.0	EL-3-016_1-33	UPDATE	Annotation	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "73", "74", or "75" for states expected to report these values according to MBES enrollment data	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "73", "74", or "75" for states expected to report these values according to public MBES enrollment data on Medicaid.gov
03/10/2023	3.4.0	EL-3-016_1-33	UPDATE	Specification	STEP 1: Measure applies to submitting state1a. If submitting state is expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are enrollees in any "Not Newly Eligible" category in the MBES enrollment data, proceed to STEP 2ELSE1b. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are NO enrollees in any “Not Newly Eligible” category in the MBES enrollment data, the final measure statistic will be displayed as "N/A"STEP 2: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 2, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 4: MSIS IDs with eligibility group 73, 74, or 75Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "73", "74", or "75"STEP 5: Calculate percentageDivide the count from STEP 4 by the count from STEP 2	STEP 1: Measure applies to submitting state1a. If submitting state is expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are enrollees in any "Not Newly Eligible" category in the MBES enrollment data, proceed to STEP 2ELSE1b. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are NO enrollees in any “Not Newly Eligible” category in the public MBES enrollment data on Medicaid.gov, the final measure statistic will be displayed as "N/A"STEP 2: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 2, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 4: MSIS IDs with eligibility group 73, 74, or 75Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "73", "74", or "75"STEP 5: Calculate percentageDivide the count from STEP 4 by the count from STEP 2
09/06/2023	3.12.0	RULE-7438	UPDATE	Adjustment type	Non-void	All Adjustment Types
09/06/2023	3.12.0	RULE-7437	UPDATE	Adjustment type	Non-void	All Adjustment Types
09/06/2023	3.12.0	RULE-7436	UPDATE	Adjustment type	Non-void	All Adjustment Types
09/06/2023	3.12.0	RULE-7435	UPDATE	Adjustment type	Non-void	All Adjustment Types
12/09/2022	3.0.6	RULE-2382	UPDATE	Priority	High	Critical
12/09/2022	3.0.6	RULE-2382	UPDATE	Category	Managed care file	File integrity
12/09/2022	3.0.6	RULE-2382	UPDATE	Ta max	0.01	0.05
12/09/2022	3.0.6	RULE-2382	UPDATE	Threshold maximum	0.01	0.05
03/10/2023	3.4.0	EL-1-025-31	UPDATE	Ta max	0.01	0.001
03/10/2023	3.4.0	EL-1-025-31	UPDATE	Threshold maximum	0.01	0.001
03/10/2023	3.4.0	EL-6-036-36	UPDATE	Priority	N/A	High
03/10/2023	3.4.0	EL-6-036-36	UPDATE	For ta comprehensive	No	TA- Inferential
03/10/2023	3.4.0	EL-6-036-36	UPDATE	For ta inferential	No	Yes
03/10/2023	3.4.0	EL-6-036-36	UPDATE	Ta min		0
03/10/2023	3.4.0	EL-6-036-36	UPDATE	Ta max		0.02
03/10/2023	3.4.0	EL-6-036-36	UPDATE	Threshold minimum	TBD	0
03/10/2023	3.4.0	EL-6-036-36	UPDATE	Threshold maximum	TBD	0.02
01/27/2023	3.2.0	EL-6-032-35	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Money Follows the Person participationOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. RESTRICTED-BENEFITS-CODE = “D”STEP 4: MFP enrollment on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment MFP-INFORMATION-ELG00010 by keeping records that satisfy the following criteria:1. MFP-ENROLLMENT-EFF-DATE <= last day of the DQ report month AND is not missing2. MFP-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingSTEP 5: No MFP EnrollmentSubtract the count of unique MSIS IDs from STEP 3 by the count of unique MSIS IDs from STEP 4STEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 54 by the count of unique MSIS IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Money Follows the Person participationOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where:1. RESTRICTED-BENEFITS-CODE = “D”STEP 4: MFP enrollment on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment MFP-INFORMATION-ELG00010 by keeping records that satisfy the following criteria:1. MFP-ENROLLMENT-EFF-DATE <= last day of the DQ report month AND is not missing2. MFP-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingSTEP 5: No MFP EnrollmentSubtract the count of unique MSIS IDs from STEP 3 by the count of unique MSIS IDs from STEP 4STEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3
03/10/2023	3.4.0	MIS-90-001-1	UPDATE	Priority	N/A	High
03/10/2023	3.4.0	MIS-90-001-1	UPDATE	For ta comprehensive	No	TA- Inferential
03/10/2023	3.4.0	MIS-90-001-1	UPDATE	For ta inferential	No	Yes
03/10/2023	3.4.0	MIS-90-001-1	UPDATE	Ta min		0
03/10/2023	3.4.0	MIS-90-001-1	UPDATE	Ta max		0.02
03/10/2023	3.4.0	MIS-90-001-1	UPDATE	Threshold minimum	TBD	0
03/10/2023	3.4.0	MIS-90-001-1	UPDATE	Threshold maximum	TBD	0.02
03/10/2023	3.4.0	MIS-90-001-1	UPDATE	Annotation	N/A	Character
03/10/2023	3.4.0	MIS-90-001-1	UPDATE	Specification	N/A	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP Capitation Payment: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
03/10/2023	3.4.0	MIS-88-001-1	UPDATE	Priority	N/A	High
03/10/2023	3.4.0	MIS-88-001-1	UPDATE	For ta comprehensive	No	TA- Inferential
03/10/2023	3.4.0	MIS-88-001-1	UPDATE	For ta inferential	No	Yes
03/10/2023	3.4.0	MIS-88-001-1	UPDATE	Ta min		0
03/10/2023	3.4.0	MIS-88-001-1	UPDATE	Ta max		0.02
03/10/2023	3.4.0	MIS-88-001-1	UPDATE	Threshold minimum	TBD	0
03/10/2023	3.4.0	MIS-88-001-1	UPDATE	Threshold maximum	TBD	0.02
03/10/2023	3.4.0	MIS-88-001-1	UPDATE	Annotation	N/A	Character
03/10/2023	3.4.0	MIS-88-001-1	UPDATE	Specification	N/A	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Capitation Payment: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
04/21/2023	3.6.0	MIS-86-020-20	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-86-018-18	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-86-015-15	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-86-014-14	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-86-003-3	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-86-002-2	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-86-002-2 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-85-026-26	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-85-025-25	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-85-023-23	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-85-022-22	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-85-021-21	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-85-019-19	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-85-016-16	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-85-014-14	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-85-011-11	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-85-010-10	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-85-009-9	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-85-007-7	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-85-006-6	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-85-005-5	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-85-004-4	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-85-014-14, MIS-85-025-25, and MIS-85-026-26 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-84-030-30	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-84-028-28	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-84-026-26	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-84-025-25	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-84-024-24	UPDATE	Priority	N/A	Medium
04/21/2023	3.6.0	MIS-84-024-24	UPDATE	Category	N/A	Utilization
04/21/2023	3.6.0	MIS-84-024-24	UPDATE	For ta comprehensive	No	TA- Inferential
04/21/2023	3.6.0	MIS-84-024-24	UPDATE	For ta inferential	No	Yes
04/21/2023	3.6.0	MIS-84-024-24	UPDATE	Ta min		0
04/21/2023	3.6.0	MIS-84-024-24	UPDATE	Ta max		0.98
04/21/2023	3.6.0	MIS-84-024-24	UPDATE	Threshold minimum	TBD	0
04/21/2023	3.6.0	MIS-84-024-24	UPDATE	Threshold maximum	TBD	0.98
04/21/2023	3.6.0	MIS-84-019-19	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-84-006-6	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-84-004-4	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-84-003-3	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-84-002-2	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-84-004-4 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-83-038-38	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-83-032-32	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-83-031-31	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-83-030-30	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-83-029-29	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-83-028-28	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-83-024-24	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-83-022-22	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-83-020-20	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-83-016-16	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-83-013-13	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-83-011-11	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-83-009-9	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-83-008-8	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-83-007-7	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-83-006-6	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-83-005-5	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-83-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-83-020-20, MIS-83-028-28, and MIS-83-029-29 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-82-017-17	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-82-014-14	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-82-013-13	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-82-012-12	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-82-011-11	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-82-003-3	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-82-002-2	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-82-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure)
04/21/2023	3.6.0	MIS-81-047-47	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),
04/21/2023	3.6.0	MIS-81-041-41	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),
04/21/2023	3.6.0	MIS-81-040-40	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),
04/21/2023	3.6.0	MIS-81-038-38	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),
04/21/2023	3.6.0	MIS-81-037-37	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),
04/21/2023	3.6.0	MIS-81-035-35	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),
04/21/2023	3.6.0	MIS-81-034-34	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),
04/21/2023	3.6.0	MIS-81-030-30	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),
04/21/2023	3.6.0	MIS-81-026-26	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),
04/21/2023	3.6.0	MIS-81-018-18	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),
04/21/2023	3.6.0	MIS-81-011-11	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),
04/21/2023	3.6.0	MIS-81-010-10	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),
04/21/2023	3.6.0	MIS-81-009-9	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),
04/21/2023	3.6.0	MIS-81-008-8	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),
04/21/2023	3.6.0	MIS-81-007-7	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),
04/21/2023	3.6.0	MIS-81-003-3	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-81-026-26, MIS-81-040-40, and MIS-81-041-41 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures),
04/21/2023	3.6.0	MIS-80-017-17	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).
04/21/2023	3.6.0	MIS-80-014-14	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).
04/21/2023	3.6.0	MIS-80-013-13	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).
04/21/2023	3.6.0	MIS-80-012-12	UPDATE	Priority	Medium	High
04/21/2023	3.6.0	MIS-80-012-12	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).
04/21/2023	3.6.0	MIS-80-011-11	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).
04/21/2023	3.6.0	MIS-80-003-3	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).
04/21/2023	3.6.0	MIS-80-002-2	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measure MIS-80-011-11 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measure), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claim lines from STEP 4 by the count of claim lines from STEP 2 (or STEP 3 for selected measure).
04/21/2023	3.6.0	MIS-79-060-60	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-059-59	UPDATE	Priority	Medium	High
04/21/2023	3.6.0	MIS-79-059-59	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-054-54	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-053-53	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-051-51	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-050-50	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-042-42	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-041-41	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-037-37	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-034-34	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-033-33	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-012-12	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-011-11	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-010-10	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-009-9	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-008-8	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-004-4	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-003-3	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-002-2	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
04/21/2023	3.6.0	MIS-79-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)
03/10/2023	3.4.0	MIS-28-003-3	UPDATE	Category	Expenditures	N/A
03/10/2023	3.4.0	MIS-28-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
03/10/2023	3.4.0	MIS-28-003-3	UPDATE	For ta inferential	Yes	No
03/10/2023	3.4.0	MIS-28-003-3	UPDATE	Threshold minimum	0	N/A
03/10/2023	3.4.0	MIS-28-003-3	UPDATE	Threshold maximum	0.02	N/A
03/10/2023	3.4.0	MIS-28-003-3	UPDATE	Annotation	Numeric	N/A
03/10/2023	3.4.0	MIS-28-003-3	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
04/21/2023	3.6.0	MIS-26-025-25	UPDATE	Priority	N/A	Medium
04/21/2023	3.6.0	MIS-26-025-25	UPDATE	Category	N/A	Utilization
04/21/2023	3.6.0	MIS-26-025-25	UPDATE	For ta comprehensive	No	TA- Inferential
04/21/2023	3.6.0	MIS-26-025-25	UPDATE	For ta inferential	No	Yes
04/21/2023	3.6.0	MIS-26-025-25	UPDATE	Ta min		0
04/21/2023	3.6.0	MIS-26-025-25	UPDATE	Ta max		0.98
04/21/2023	3.6.0	MIS-26-025-25	UPDATE	Threshold minimum	TBD	0
04/21/2023	3.6.0	MIS-26-025-25	UPDATE	Threshold maximum	TBD	0.98
03/10/2023	3.4.0	MIS-26-005-5	UPDATE	Category	Expenditures	N/A
03/10/2023	3.4.0	MIS-26-005-5	UPDATE	For ta comprehensive	TA- Inferential	No
03/10/2023	3.4.0	MIS-26-005-5	UPDATE	For ta inferential	Yes	No
03/10/2023	3.4.0	MIS-26-005-5	UPDATE	Threshold minimum	0	N/A
03/10/2023	3.4.0	MIS-26-005-5	UPDATE	Threshold maximum	0.1	N/A
03/10/2023	3.4.0	MIS-26-005-5	UPDATE	Annotation	Numeric	N/A
03/10/2023	3.4.0	MIS-26-005-5	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
03/10/2023	3.4.0	MIS-24-012-12	UPDATE	Category	Expenditures	N/A
03/10/2023	3.4.0	MIS-24-012-12	UPDATE	For ta comprehensive	TA- Inferential	No
03/10/2023	3.4.0	MIS-24-012-12	UPDATE	For ta inferential	Yes	No
03/10/2023	3.4.0	MIS-24-012-12	UPDATE	Threshold minimum	0	N/A
03/10/2023	3.4.0	MIS-24-012-12	UPDATE	Threshold maximum	0.02	N/A
03/10/2023	3.4.0	MIS-24-012-12	UPDATE	Annotation	Numeric	N/A
03/10/2023	3.4.0	MIS-24-012-12	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
04/21/2023	3.6.0	MIS-22-013-13	UPDATE	Priority	Medium	High
03/10/2023	3.4.0	MIS-22-012-12	UPDATE	Category	Expenditures	N/A
03/10/2023	3.4.0	MIS-22-012-12	UPDATE	For ta comprehensive	TA- Inferential	No
03/10/2023	3.4.0	MIS-22-012-12	UPDATE	For ta inferential	Yes	No
03/10/2023	3.4.0	MIS-22-012-12	UPDATE	Threshold minimum	0	N/A
03/10/2023	3.4.0	MIS-22-012-12	UPDATE	Threshold maximum	0.02	N/A
03/10/2023	3.4.0	MIS-22-012-12	UPDATE	Annotation	Numeric	N/A
03/10/2023	3.4.0	MIS-22-012-12	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	N/A
04/21/2023	3.6.0	MIS-21-059-59	UPDATE	Priority	Medium	High
12/09/2022	3.0.6	RULE-7379	UPDATE	Measure name	% missing: XXI-MBESCBES-CATEGORY-OF-SERVICE (CRX00003)	% of non-zero paid claim lines with Title XXI funding with missing XXI-MBESCBES-CATEGORY-OF-SERVICE (CRX00003)
12/09/2022	3.0.6	RULE-7378	UPDATE	Measure name	% missing: XXI-MBESCBES-CATEGORY-OF-SERVICE (COT00003)	% of non-zero paid claim lines with Title XXI funding with missing XXI-MBESCBES-CATEGORY-OF-SERVICE (COT00003)
12/09/2022	3.0.6	RULE-7377	UPDATE	Measure name	% missing: XXI-MBESCBES-CATEGORY-OF-SERVICE (CLT00003)	% of non-zero paid claim lines with Title XXI funding with missing XXI-MBESCBES-CATEGORY-OF-SERVICE (CLT00003)
12/09/2022	3.0.6	RULE-7376	UPDATE	Measure name	% missing: XXI-MBESCBES-CATEGORY-OF-SERVICE (CIP00003)	% of non-zero paid claim lines with Title XXI funding with missing XXI-MBESCBES-CATEGORY-OF-SERVICE (CIP00003)
12/09/2022	3.0.6	RULE-7375	UPDATE	Measure name	% missing: XIX-MBESCBES-CATEGORY-OF-SERVICE (CRX00003)	% of non-zero paid claim lines with Title XIX funding with missing XIX-MBESCBES-CATEGORY-OF-SERVICE (CRX00003)
12/09/2022	3.0.6	RULE-7374	UPDATE	Measure name	% missing: XIX-MBESCBES-CATEGORY-OF-SERVICE (COT00003)	% of non-zero paid claim lines with Title XIX funding with missing XIX-MBESCBES-CATEGORY-OF-SERVICE (COT00003)
12/09/2022	3.0.6	RULE-7373	UPDATE	Measure name	% missing: XIX-MBESCBES-CATEGORY-OF-SERVICE (CLT00003)	% of non-zero paid claim lines with Title XIX funding with missing XIX-MBESCBES-CATEGORY-OF-SERVICE (CLT00003)
12/09/2022	3.0.6	RULE-7372	UPDATE	Measure name	% missing: XIX-MBESCBES-CATEGORY-OF-SERVICE (CIP00003)	% of non-zero paid claim lines with Title XIX funding with missing XIX-MBESCBES-CATEGORY-OF-SERVICE (CIP00003)
12/09/2022	3.0.6	RULE-810	UPDATE	Category	Provider identifiers	Provider information
12/09/2022	3.0.6	RULE-689	UPDATE	Category	Provider identifiers	Provider information
12/22/2022	3.1.0	Data Elements	UPDATE	Description	Specifications for the data quality measures performed on a file.	Specifications for all the data elements including valid values and related rules and measures.
12/09/2022	3.0.6	RULE-1964	UPDATE	Category	Provider identifiers	Provider information
12/09/2022	3.0.6	RULE-1845	UPDATE	Category	Provider identifiers	Provider information
12/09/2022	3.0.6	RULE-1663	UPDATE	Category	Provider identifiers	Provider information
12/09/2022	3.0.6	RULE-1540	UPDATE	Category	Provider identifiers	Provider information
12/09/2022	3.0.6	RULE-1246	UPDATE	Category	Provider identifiers	Provider information
12/09/2022	3.0.6	RULE-1126	UPDATE	Category	Provider identifiers	Provider information
12/09/2022	3.0.6	PRV-6-004-4	UPDATE	Priority	Medium	N/A
12/09/2022	3.0.6	PRV-6-004-4	UPDATE	Category	Provider identifiers	N/A
12/09/2022	3.0.6	PRV-6-004-4	UPDATE	For ta comprehensive	TA- Inferential	No
12/09/2022	3.0.6	PRV-6-004-4	UPDATE	For ta inferential	Yes	No
12/09/2022	3.0.6	PRV-6-004-4	UPDATE	Ta min	0
12/09/2022	3.0.6	PRV-6-004-4	UPDATE	Ta max	0.02
12/09/2022	3.0.6	PRV-6-003-3	UPDATE	Priority	Medium	N/A
12/09/2022	3.0.6	PRV-6-003-3	UPDATE	Category	Provider identifiers	N/A
12/09/2022	3.0.6	PRV-6-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
12/09/2022	3.0.6	PRV-6-003-3	UPDATE	For ta inferential	Yes	No
12/09/2022	3.0.6	PRV-6-003-3	UPDATE	Ta min	0
12/09/2022	3.0.6	PRV-6-003-3	UPDATE	Ta max	0.02
12/09/2022	3.0.6	PRV-6-002-2	UPDATE	Priority	Medium	N/A
12/09/2022	3.0.6	PRV-6-002-2	UPDATE	Category	Provider identifiers	N/A
12/09/2022	3.0.6	PRV-6-002-2	UPDATE	For ta comprehensive	TA- Inferential	No
12/09/2022	3.0.6	PRV-6-002-2	UPDATE	For ta inferential	Yes	No
12/09/2022	3.0.6	PRV-6-002-2	UPDATE	Ta min	0
12/09/2022	3.0.6	PRV-6-002-2	UPDATE	Ta max	0.1
12/09/2022	3.0.6	PRV-6-002-2	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE <= last day of the reporting month3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is an individualOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "03" STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Lookup Designation is "Facility or Group" or missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1a. PROV-CLASSIFICATION-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Provider Classification lookup tableAND1b. Provider Classification Lookup Designation = “Facility” or "Group"OR2. PROV-CLASSIFICATION-TYPE and PROVIDER-CLASSIFICATION-CODE do not equal to values in Provider Classification lookup tableOR3. PROV-CLASSIFICATION-TYPE is missingOR4. PROVIDER-CLASSIFICATION-CODE is missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE <= last day of the reporting month3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is an individualOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "03" STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Lookup Designation is "Facility or Group" or missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1a. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Provider Classification lookup tableAND1b. Provider Classification Lookup Designation = “Facility” or "Group"OR2. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE do not equal to values in Provider Classification lookup tableOR3. PROV-IDENTIFIER-TYPE is missingOR4. PROVIDER-CLASSIFICATION-CODE is missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3
12/09/2022	3.0.6	PRV-6-001-1	UPDATE	Priority	Medium	N/A
12/09/2022	3.0.6	PRV-6-001-1	UPDATE	Category	Provider identifiers	N/A
12/09/2022	3.0.6	PRV-6-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
12/09/2022	3.0.6	PRV-6-001-1	UPDATE	For ta inferential	Yes	No
12/09/2022	3.0.6	PRV-6-001-1	UPDATE	Ta min	0
12/09/2022	3.0.6	PRV-6-001-1	UPDATE	Ta max	0.1
12/09/2022	3.0.6	PRV-6-001-1	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE <= last day of the reporting month3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is a facility or groupOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "01" or "02" STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Lookup Designation is "Individual" or missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1a. PROV-CLASSIFICATION-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Provider Classification lookup tableAND1b. Provider Classification Lookup Designation = “Individual”OR2. PROV-CLASSIFICATION-TYPE and PROVIDER-CLASSIFICATION-CODE do not equal to values in Provider Classification lookup tableOR3. PROV-CLASSIFICATION-TYPE is missingOR4. PROVIDER-CLASSIFICATION-CODE is missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider attributes are active on last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria:1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month2. PROV-ATTRIBUTES-END-DATE <= last day of the reporting month3. SUBMITTING-STATE-PROV-ID is not missingSTEP 3: Provider is a facility or groupOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. FACILITY-GROUP-INDIVIDUAL-CODE = "01" or "02" STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider Classification Lookup Designation is "Individual" or missingOf the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria:1a. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Provider Classification lookup tableAND1b. Provider Classification Lookup Designation = “Individual”OR2. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE do not equal to values in Provider Classification lookup tableOR3. PROV-IDENTIFIER-TYPE is missingOR4. PROVIDER-CLASSIFICATION-CODE is missingSTEP 6: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3
01/27/2023	3.2.0	PRV-2-010-10	UPDATE	Priority	High	N/A
01/27/2023	3.2.0	PRV-2-010-10	UPDATE	Category	Provider identifiers	N/A
01/27/2023	3.2.0	PRV-2-010-10	UPDATE	For ta comprehensive	TA- Inferential	No
01/27/2023	3.2.0	PRV-2-010-10	UPDATE	For ta inferential	Yes	No
01/27/2023	3.2.0	PRV-2-010-10	UPDATE	Ta min	0
01/27/2023	3.2.0	PRV-2-010-10	UPDATE	Ta max	0.01
04/21/2023	3.6.0	PRV-2-009-9	UPDATE	Annotation	Calculate the percent of submitting-state-provider-IDs that have an NPI, but not a taxonomy code	Calculate the percent of submitting state provider IDs that have an NPI, but not a taxonomy code
04/21/2023	3.6.0	PRV-2-009-9	UPDATE	Specification	STEP 1: Provider enrolled on the last of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missing STEP 2: Provider identifier is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROV-IDENTIFIER-PRV00005 by keeping records that satisfy the following criteria:1a. PROV-IDENTIFIER-EFF-DATE <= last day of the reporting month2a. PROV-IDENTIFIER-END-DATE >= last day of the reporting month OR missingOR1b. PROV-IDENTIFIER-EFF-DATE is missing2b. PROV-IDENTIFIER-END-DATE is missingSTEP 3: Provider classification type is "NPI"Of the providers that meet the criteria from STEP 2, keep records that satisfy the following criteria: 1. PROV-IDENTIFIER-TYPE = 2STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider classification is taxonomyOf the providers that meet the criteria from STEP 4, keep records that satisfy the following criteria: 1. PROV-CLASSIFICATION-TYPE is = 1STEP 6: Calculate percent that have a taxonomyDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 5 by the count from STEP 3STEP 7: Calculate percent that do not have any taxonomy codesSubtract the percent from STEP 6 from 1	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missing STEP 2: Provider identifier is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROV-IDENTIFIER-PRV00005 by keeping records that satisfy the following criteria:1a. PROV-IDENTIFIER-EFF-DATE <= last day of the reporting month2a. PROV-IDENTIFIER-END-DATE >= last day of the reporting month OR missingOR1b. PROV-IDENTIFIER-EFF-DATE is missing2b. PROV-IDENTIFIER-END-DATE is missingSTEP 3: Provider classification type is "NPI"Of the providers that meet the criteria from STEP 2, keep records that satisfy the following criteria: 1. PROV-IDENTIFIER-TYPE = 2STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider classification is taxonomyOf the providers that meet the criteria from STEP 4, keep records that satisfy the following criteria: 1. PROV-CLASSIFICATION-TYPE is = 1STEP 6: Calculate percent that have a taxonomyDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 5 by the count from STEP 3STEP 7: Calculate percent that do not have any taxonomy codesSubtract the percent from STEP 6 from 1
04/21/2023	3.6.0	PRV-2-002-2	UPDATE	Annotation	N/A	Calculate the percent of submitting state provider IDs that have an NPI
04/21/2023	3.6.0	PRV-2-002-2	UPDATE	Specification	N/A	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missing STEP 2: Provider identifier is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROV-IDENTIFIER-PRV00005 by keeping records that satisfy the following criteria:1a. PROV-IDENTIFIER-EFF-DATE <= last day of the reporting month2a. PROV-IDENTIFIER-END-DATE >= last day of the reporting month OR missingOR1b. PROV-IDENTIFIER-EFF-DATE is missing2b. PROV-IDENTIFIER-END-DATE is missingSTEP 3: Provider classification type is "NPI"Of the providers that meet the criteria from STEP 2, keep records that satisfy the following criteria: 1. PROV-IDENTIFIER-TYPE = 2STEP 4: Calculate percent that that have NPIDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count from STEP 2
09/06/2023	3.12.0	MIS-30-003-3	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Capitation Payment: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2" or "B"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Capitation Payment: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2" or "B"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
09/06/2023	3.12.0	MIS-30-002-2	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Capitation Payment: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2" or "B"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Capitation Payment: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2" or "B"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
09/06/2023	3.12.0	MIS-30-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Capitation Payment: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2" or "B"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Capitation Payment: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2" or "B"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
12/09/2022	3.0.6	MIS-28-001-1	UPDATE	Ta max	0.02	0.1
12/09/2022	3.0.6	MIS-28-001-1	UPDATE	Threshold maximum	0.02	0.1
12/09/2022	3.0.6	MIS-26-001-1	UPDATE	Ta max	0.02	0.1
12/09/2022	3.0.6	MIS-26-001-1	UPDATE	Threshold maximum	0.02	0.1
12/09/2022	3.0.6	MIS-24-001-1	UPDATE	Ta max	0.02	0.1
12/09/2022	3.0.6	MIS-24-001-1	UPDATE	Threshold maximum	0.02	0.1
12/09/2022	3.0.6	MIS-22-001-1	UPDATE	Ta max	0.02	0.1
12/09/2022	3.0.6	MIS-22-001-1	UPDATE	Threshold maximum	0.02	0.1
09/06/2023	3.12.0	MIS-11-010-10	UPDATE	Active	True	False
09/06/2023	3.12.0	MIS-11-010-10	UPDATE	Annotation	Alphanumeric	N/A
09/06/2023	3.12.0	MIS-11-010-10	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment (PRV000XX)STEP 2: Alphanumeric missing flagCreate a binary flag called Alphanumeric_Missing that is equal to 1 when1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9STEP 3: All alphanumeric missingOf the SUBMITTING-STATE-PROV-IDs identified in STEP 1, select those where Alphanumeric_Missing = 1 for all record segments for each particular SUBMITTING-STATE-PROV-IDSTEP 4: Calculate percentageDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count of unique SUBMITTING-STATE-PROV-IDs from STEP 1	N/A
09/06/2023	3.12.0	MIS-1-092-92	UPDATE	Priority	High	N/A
09/06/2023	3.12.0	MIS-1-092-92	UPDATE	Category	Beneficiary eligibility	N/A
09/06/2023	3.12.0	MIS-1-092-92	UPDATE	For ta comprehensive	TA- Inferential	No
09/06/2023	3.12.0	MIS-1-092-92	UPDATE	For ta inferential	Yes	No
09/06/2023	3.12.0	MIS-1-092-92	UPDATE	Ta min	0
09/06/2023	3.12.0	MIS-1-092-92	UPDATE	Ta max	0.02
09/06/2023	3.12.0	MIS-1-032-32	UPDATE	Priority	High	N/A
09/06/2023	3.12.0	MIS-1-032-32	UPDATE	Category	Beneficiary eligibility	N/A
09/06/2023	3.12.0	MIS-1-032-32	UPDATE	For ta comprehensive	TA- Inferential	No
09/06/2023	3.12.0	MIS-1-032-32	UPDATE	For ta inferential	Yes	No
09/06/2023	3.12.0	MIS-1-032-32	UPDATE	Ta min	0
09/06/2023	3.12.0	MIS-1-032-32	UPDATE	Ta max	0.02
09/06/2023	3.12.0	MIS-1-021-21	UPDATE	Priority	High	N/A
09/06/2023	3.12.0	MIS-1-021-21	UPDATE	Category	Beneficiary demographics	N/A
09/06/2023	3.12.0	MIS-1-021-21	UPDATE	For ta comprehensive	TA- Inferential	No
09/06/2023	3.12.0	MIS-1-021-21	UPDATE	For ta inferential	Yes	No
09/06/2023	3.12.0	MIS-1-021-21	UPDATE	Ta min	0
09/06/2023	3.12.0	MIS-1-021-21	UPDATE	Ta max	0.02
09/06/2023	3.12.0	MIS-1-020-20	UPDATE	Priority	High	N/A
09/06/2023	3.12.0	MIS-1-020-20	UPDATE	Category	Beneficiary demographics	N/A
09/06/2023	3.12.0	MIS-1-020-20	UPDATE	For ta comprehensive	TA- Inferential	No
09/06/2023	3.12.0	MIS-1-020-20	UPDATE	For ta inferential	Yes	No
09/06/2023	3.12.0	MIS-1-020-20	UPDATE	Ta min	0
09/06/2023	3.12.0	MIS-1-020-20	UPDATE	Ta max	0.02
09/06/2023	3.12.0	MIS-1-006-6	UPDATE	Priority	High	N/A
09/06/2023	3.12.0	MIS-1-006-6	UPDATE	Category	Beneficiary demographics	N/A
09/06/2023	3.12.0	MIS-1-006-6	UPDATE	For ta comprehensive	TA- Inferential	No
09/06/2023	3.12.0	MIS-1-006-6	UPDATE	For ta inferential	Yes	No
09/06/2023	3.12.0	MIS-1-006-6	UPDATE	Ta min	0
09/06/2023	3.12.0	MIS-1-006-6	UPDATE	Ta max	0.1
09/06/2023	3.12.0	MIS-1-001-1	UPDATE	Priority	High	N/A
09/06/2023	3.12.0	MIS-1-001-1	UPDATE	Category	Beneficiary demographics	N/A
09/06/2023	3.12.0	MIS-1-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
09/06/2023	3.12.0	MIS-1-001-1	UPDATE	For ta inferential	Yes	No
09/06/2023	3.12.0	MIS-1-001-1	UPDATE	Ta min	0
09/06/2023	3.12.0	MIS-1-001-1	UPDATE	Ta max	0.02
04/21/2023	3.6.0	MCR-9-006_1-18	UPDATE	Measure name	% of PCCM (TYPE-OF-SERVICE) capitated payments with a non-missing plan ID that do not have a corresponding managed care participation PCCM plan	% of PCCM (TYPE-OF-SERVICE) capitation payments with a non-missing plan ID that do not have a corresponding managed care participation PCCM plan
04/21/2023	3.6.0	MCR-9-006_1-18	UPDATE	Annotation	Calculate the percentage of PCCM capitated payments with a non-missing Plan Id that do not have a corresponding managed care participation PCCM plan	Calculate the percentage of PCCM capitation payments with a non-missing plan id that do not have a corresponding managed care participation PCCM plan
04/21/2023	3.6.0	MCR-9-006_1-18	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2"2. ADJUSTMENT-IND = "0"STEP 3: Type of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "120"STEP 4: Non-missing plan idOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. PLAN-ID-NUMBER is not missingSTEP 5: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 6: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 5, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 7: No managed care participation PCCM planOf the claim lines that meet the criteria from STEP 4, further restrict them by attempting to merge them with the data from STEP 6 and keeping those that satisfy the following criteria:1a. PLAN-ID-NUMBER = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal "02" for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PLAN-ID-NUMBER = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 8: Calculate the percentage for the measureDivide the count of claims from STEP 7 by the count of claims from STEP 4	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "2"2. ADJUSTMENT-IND = "0"STEP 3: Type of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "120"STEP 4: Non-missing plan idOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. PLAN-ID-NUMBER is not missingSTEP 5: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 6: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 5, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 7: No managed care participation PCCM planOf the claim lines that meet the criteria from STEP 4, further restrict them by attempting to merge them with the data from STEP 6 and keeping those that satisfy the following criteria:1a. PLAN-ID-NUMBER = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal "02" or "03" for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PLAN-ID-NUMBER = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 8: Calculate the percentage for the measureDivide the count of claims from STEP 7 by the count of claims from STEP 4
04/21/2023	3.6.0	MCR-64-004-4	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	MCR-64-004-4	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP encounter: original and adjustment, crossover, paid RX claims where Medicare paid amount, total Medicare coinsurance amount, and total Medicare deductible amount are equal to 0 or are missing	N/A
04/21/2023	3.6.0	MCR-64-004-4	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"STEP 3: No Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing on all lines2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers from STEP 2	N/A
04/21/2023	3.6.0	MCR-64-003-3	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	MCR-64-003-3	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP encounter: original and adjustment, crossover, paid OT claims where Medicare paid amount, total Medicare coinsurance amount, and total Medicare deductible amount are equal to 0 or are missing	N/A
04/21/2023	3.6.0	MCR-64-003-3	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"STEP 3: No Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing on all lines2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers from STEP 2	N/A
04/21/2023	3.6.0	MCR-64-002-2	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	MCR-64-002-2	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP encounter: original and adjustment, crossover, paid LT claims where Medicare paid amount, total Medicare coinsurance amount, and total Medicare deductible amount are equal to 0 or are missing	N/A
04/21/2023	3.6.0	MCR-64-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"STEP 3: No Medicare Amounts Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers from STEP 2	N/A
04/21/2023	3.6.0	MCR-64-001-1	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	MCR-64-001-1	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP encounter: original and adjustment, crossover, paid IP claims where Medicare paid amount, total Medicare coinsurance amount, and total Medicare deductible amount are equal to 0 or are missing	N/A
04/21/2023	3.6.0	MCR-64-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-IND = "1"STEP 3: No Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers from STEP 2	N/A
04/21/2023	3.6.0	MCR-63-004-4	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	MCR-63-004-4	UPDATE	Category	Expenditures	N/A
04/21/2023	3.6.0	MCR-63-004-4	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	MCR-63-004-4	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	MCR-63-004-4	UPDATE	Ta min	0
04/21/2023	3.6.0	MCR-63-004-4	UPDATE	Ta max	0.001
04/21/2023	3.6.0	MCR-63-004-4	UPDATE	Adjustment type	All Adjustment Types	Original and Replacement
04/21/2023	3.6.0	MCR-63-004-4	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP encounter: original and adjustment, non-crossover, paid RX claims where Medicare paid amount, total Medicare coinsurance amount, or total Medicare deductible amount is non-zero	N/A
04/21/2023	3.6.0	MCR-63-004-4	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Non-zero Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1a. MEDICARE-PAID-AMT is non-zero on any lineOR1b. TOT-MEDICARE-COINS-AMT is non-zeroOR 1c. TOT-MEDICARE-DEDUCTIBLE-AMT is non-zeroSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers in STEP 2	N/A
04/21/2023	3.6.0	MCR-63-003-3	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	MCR-63-003-3	UPDATE	Category	Expenditures	N/A
04/21/2023	3.6.0	MCR-63-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	MCR-63-003-3	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	MCR-63-003-3	UPDATE	Ta min	0
04/21/2023	3.6.0	MCR-63-003-3	UPDATE	Ta max	0.001
04/21/2023	3.6.0	MCR-63-003-3	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP encounter: original and adjustment, non-crossover, paid OT claims where Medicare paid amount, total Medicare coinsurance amount, or total Medicare deductible amount is non-zero	N/A
04/21/2023	3.6.0	MCR-63-003-3	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Non-zero Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1a. MEDICARE-PAID-AMT is non-zero on any lineOR1b. TOT-MEDICARE-COINS-AMT is non-zeroOR 1c. TOT-MEDICARE-DEDUCTIBLE-AMT is non-zeroSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers in STEP 2	N/A
04/21/2023	3.6.0	MCR-63-002-2	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	MCR-63-002-2	UPDATE	Category	Expenditures	N/A
04/21/2023	3.6.0	MCR-63-002-2	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	MCR-63-002-2	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	MCR-63-002-2	UPDATE	Ta min	0
04/21/2023	3.6.0	MCR-63-002-2	UPDATE	Ta max	0.001
04/21/2023	3.6.0	MCR-63-002-2	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP encounter: original and adjustment, non-crossover, paid LT claims where Medicare paid amount, total Medicare coinsurance amount, or total Medicare deductible amount is non-zero	N/A
04/21/2023	3.6.0	MCR-63-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Non-zero Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1a. MEDICARE-PAID-AMT is non-zeroOR1b. TOT-MEDICARE-COINS-AMT is non-zeroOR 1c. TOT-MEDICARE-DEDUCTIBLE-AMT is non-zeroSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers in STEP 2	N/A
04/21/2023	3.6.0	MCR-63-001-1	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	MCR-63-001-1	UPDATE	Category	Expenditures	N/A
04/21/2023	3.6.0	MCR-63-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	MCR-63-001-1	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	MCR-63-001-1	UPDATE	Ta min	0
04/21/2023	3.6.0	MCR-63-001-1	UPDATE	Ta max	0.001
04/21/2023	3.6.0	MCR-63-001-1	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP encounter: original and adjustment, non-crossover, paid IP claims where Medicare paid amount, total Medicare coinsurance amount, or total Medicare deductible amount is non-zero	N/A
04/21/2023	3.6.0	MCR-63-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original and Adjustment, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Non-zero Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1a. MEDICARE-PAID-AMT is non-zeroOR1b. TOT-MEDICARE-COINS-AMT is non-zeroOR 1c. TOT-MEDICARE-DEDUCTIBLE-AMT is non-zeroSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers in STEP 2	N/A
04/21/2023	3.6.0	MCR-59-012-12	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP Encounter: original, paid RX claim lines with a payment level indicator of 2 where the Medicaid paid amount is greater than the allowed amount	N/A
04/21/2023	3.6.0	MCR-59-012-12	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Claim Line DetailOf the claims that meet the criteria from STEP2, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 4: Non-missing Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 5: Medicaid paid is greater than allowedOf the records from STEP 4, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 6: PercentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4	N/A
04/21/2023	3.6.0	MCR-59-011-11	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Claim Line DetailOf the claims that meet the criteria from STEP2, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 4: Non-missing Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 5: Medicaid paid is greater than allowedOf the records from STEP 4, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 6: PercentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Claim Line DetailOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Non-missing Medicaid paid and allowed amountsOf the records from STEP 4, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 6: Medicaid paid is greater than allowedOf the records from STEP 5, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 7: PercentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5.
04/21/2023	3.6.0	MCR-59-010-10	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Claim Line DetailOf the claims that meet the criteria from STEP2, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 4: Non-missing Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 5: Medicaid paid is greater than allowedOf the records from STEP 4, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 6: PercentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Claim Line DetailOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Non-missing Medicaid paid and allowed amountsOf the records from STEP 4, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 6: Medicaid paid is greater than allowedOf the records from STEP 5, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 7: PercentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5.
04/21/2023	3.6.0	MCR-59-009-9	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Claim Line DetailOf the claims that meet the criteria from STEP2, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 4: Non-missing Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 5: Medicaid paid is greater than allowedOf the records from STEP 4, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 6: PercentageDivide the count of claim lines from STEP 5 by the count of claim lines from STEP 4	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Claim Line DetailOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Non-missing Medicaid paid and allowed amountsOf the records from STEP 4, further refine the population with the following criteria: 1. MEDICAID-PAID-AMT is not missing2. ALLOWED-AMT is not missing3. ALLOWED-AMT is not equal to 0STEP 6: Medicaid paid is greater than allowedOf the records from STEP 5, further refine the population with the following criteria:1. MEDICAID-PAID-AMT > ALLOWED-AMTSTEP 7: PercentageDivide the count of claim lines from STEP 6 by the count of claim lines from STEP 5.
04/21/2023	3.6.0	MCR-59-008-8	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP Encounter: original, paid RX claims where the total Medicaid paid amount is greater than the total allowed amount	N/A
04/21/2023	3.6.0	MCR-59-008-8	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0"STEP 3: Non-missing total Medicaid paid and allowed amountsOf the records from STEP 2, further refine the population with the following criteria: 1. TOT-MEDICAID-PAID-AMT is not missing2. TOT-ALLOWED-AMT is not missing3. TOT-ALLOWED-AMT is not equal to 0STEP 4: Total Medicaid paid is greater than total allowed Of the records from STEP 3, further refine the population with the following criteria:1. TOT-MEDICAID-PAID-AMT > TOT-ALLOWED-AMTSTEP 5: PercentageDivide the count of claims from STEP 4 by the count of claims from STEP 3	N/A
04/21/2023	3.6.0	MCR-59-007-7	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0"STEP 3: Non-missing total Medicaid paid and allowed amountsOf the records from STEP 2, further refine the population with the following criteria: 1. TOT-MEDICAID-PAID-AMT is not missing2. TOT-ALLOWED-AMT is not missing3. TOT-ALLOWED-AMT is not equal to 0STEP 4: Total Medicaid paid is greater than total allowed Of the records from STEP 3, further refine the population with the following criteria:1. TOT-MEDICAID-PAID-AMT > TOT-ALLOWED-AMTSTEP 5: PercentageDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Non-missing total Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. TOT-MEDICAID-PAID-AMT is not missing2. TOT-ALLOWED-AMT is not missing3. TOT-ALLOWED-AMT is not equal to 0STEP 5: Total Medicaid paid is greater than total allowed Of the records from STEP 4, further refine the population with the following criteria:1. TOT-MEDICAID-PAID-AMT > TOT-ALLOWED-AMTSTEP 6: PercentageDivide the count of claims from STEP 5 by the count of claims from STEP 4.
04/21/2023	3.6.0	MCR-59-006-6	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0"STEP 3: Non-missing total Medicaid paid and allowed amountsOf the records from STEP 2, further refine the population with the following criteria: 1. TOT-MEDICAID-PAID-AMT is not missing2. TOT-ALLOWED-AMT is not missing3. TOT-ALLOWED-AMT is not equal to 0STEP 4: Total Medicaid paid is greater than total allowed Of the records from STEP 3, further refine the population with the following criteria:1. TOT-MEDICAID-PAID-AMT > TOT-ALLOWED-AMTSTEP 5: PercentageDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Non-missing total Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. TOT-MEDICAID-PAID-AMT is not missing2. TOT-ALLOWED-AMT is not missing3. TOT-ALLOWED-AMT is not equal to 0STEP 5: Total Medicaid paid is greater than total allowed Of the records from STEP 4, further refine the population with the following criteria:1. TOT-MEDICAID-PAID-AMT > TOT-ALLOWED-AMTSTEP 6: PercentageDivide the count of claims from STEP 5 by the count of claims from STEP 4.
04/21/2023	3.6.0	MCR-59-005-5	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0"STEP 3: Non-missing total Medicaid paid and allowed amountsOf the records from STEP 2, further refine the population with the following criteria: 1. TOT-MEDICAID-PAID-AMT is not missing2. TOT-ALLOWED-AMT is not missing3. TOT-ALLOWED-AMT is not equal to 0STEP 4: Total Medicaid paid is greater than total allowed Of the records from STEP 3, further refine the population with the following criteria:1. TOT-MEDICAID-PAID-AMT > TOT-ALLOWED-AMTSTEP 5: PercentageDivide the count of claims from STEP 4 by the count of claims from STEP 3	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Non-missing total Medicaid paid and allowed amountsOf the records from STEP 3, further refine the population with the following criteria: 1. TOT-MEDICAID-PAID-AMT is not missing2. TOT-ALLOWED-AMT is not missing3. TOT-ALLOWED-AMT is not equal to 0STEP 5: Total Medicaid paid is greater than total allowed Of the records from STEP 4, further refine the population with the following criteria:1. TOT-MEDICAID-PAID-AMT > TOT-ALLOWED-AMTSTEP 6: PercentageDivide the count of claims from STEP 5 by the count of claims from STEP 4.
04/21/2023	3.6.0	MCR-59-004-16	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude childless headersOf the claim headers that meet the criteria from STEP 2, drop all headers that do not merge to at least one lineSTEP 4: Claims paid at the line levelOf claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 2, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 6: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 5 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 7: Calculate the percentage for the measureDivide the count of header claims from STEP 6 by the count of header claims from STEP 4	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 3, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of header claims from STEP 7 by the count of header claims from STEP 5.
04/21/2023	3.6.0	MCR-59-003-15	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude childless headersOf the claim headers that meet the criteria from STEP 2, drop all headers that do not merge to at least one lineSTEP 4: Claims paid at the line levelOf claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 2, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 6: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 5 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 7: Calculate the percentage for the measureDivide the count of header claims from STEP 6 by the count of header claims from STEP 4	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 3, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of header claims from STEP 7 by the count of header claims from STEP 5.
04/21/2023	3.6.0	MCR-59-002-14	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude childless headersOf the claim headers that meet the criteria from STEP 2, drop all headers that do not merge to at least one lineSTEP 4: Claims paid at the line levelOf claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 2, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 6: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 5 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 7: Calculate the percentage for the measureDivide the count of header claims from STEP 6 by the count of header claims from STEP 4	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 3, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of header claims from STEP 7 by the count of header claims from STEP 5.
04/21/2023	3.6.0	MCR-59-001-13	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude childless headersOf the claim headers that meet the criteria from STEP 2, drop all headers that do not merge to at least one lineSTEP 4: Claims paid at the line levelOf claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 2, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 6: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 5 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 7: Calculate the percentage for the measureDivide the count of header claims from STEP 6 by the count of header claims from STEP 4	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Exclude childless headersOf the claim headers that meet the criteria from STEP 3, drop all headers that do not merge to at least one lineSTEP 5: Claims paid at the line levelOf claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 6: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 3, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 7: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 6 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 8: Calculate the percentage for the measureDivide the count of header claims from STEP 7 by the count of header claims from STEP 5.
04/21/2023	3.6.0	MCR-54-008-8	UPDATE	Annotation	Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some encounters that have a encounter ax ratio outside of (0.02, 5), with plan types equal to 01, 04, 18, or 80	Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some encounters that have an encounter RX ratio outside of (0.02, 5), with plan types equal to 01, 04, 18, or 80
04/21/2023	3.6.0	MCR-54-008-8	UPDATE	Specification	STEP 1: Include Comprehensive MCO, HIO, Pharmacy PAHP, and Integrated Care for Duals Plan TypesOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El is equal to ("01","04", "18", or "80")STEP 2: Enrollment and encountersOf the Plan_Ids that meet the criteria in STEP 1, further refine them by keeping those that satisfy the following criteria:1. Enrollment >= 1002. Total_Encounters > 0STEP 3: Encounters OT ratio out of expected rangeOf the Plan_Ids that meet the criteria in STEP 2, count the non-missing Plan_Ids where:1. Encounters_Rx_Ratio < 0.02 OR Encounters_Rx_Ratio > 5	STEP 1: Include Comprehensive MCO, HIO, Pharmacy PAHP, and Integrated Care for Duals Plan TypesOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El is equal to ("01","04", "18", or "80")STEP 2: Enrollment and encountersOf the Plan_Ids that meet the criteria in STEP 1, further refine them by keeping those that satisfy the following criteria:1. Enrollment >= 1002. Total_Encounters > 0STEP 3: Encounters RX ratio out of expected rangeOf the Plan_Ids that meet the criteria in STEP 2, count the non-missing Plan_Ids where:1. Encounters_Rx_Ratio < 0.02 OR Encounters_Rx_Ratio > 5
04/21/2023	3.6.0	MCR-54-007-7	UPDATE	Annotation	Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some encounters that have a encounter opt ratio outside of (0.1, 20), with plan types equal to 01, 04, 05, 06, 07, 08, 09, 10, 11, 12, 13, 14, 15, 16, or 80	Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some encounters that have an encounter OT ratio outside of (0.1, 20), with plan types equal to 01, 04, 05, 06, 07, 08, 09, 10, 11, 12, 13, 14, 15, 16, or 80
04/21/2023	3.6.0	MCR-54-006-6	UPDATE	Annotation	Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some encounters that have a encounter imp ratio outside of (0.012, 2), with plan types equal to 01, 04, or 80	Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some encounters that have an encounter IP ratio outside of (0.012, 2), with plan types equal to 01, 04, or 80
04/21/2023	3.6.0	MCR-13-006_1-18	UPDATE	Measure name	% of PCCM (TYPE-OF-SERVICE) capitated payments with a non-missing plan ID that do not have a corresponding managed care participation PCCM plan	% of PCCM (TYPE-OF-SERVICE) capitation payments with a non-missing plan ID that do not have a corresponding managed care participation PCCM plan
04/21/2023	3.6.0	MCR-13-006_1-18	UPDATE	Annotation	Calculate the percentage of PCCM capitated payments with a non-missing plan id that do not have a corresponding managed care participation PCCM plan	Calculate the percentage of PCCM capitation payments with a non-missing plan ID that do not have a corresponding managed care participation PCCM plan
04/21/2023	3.6.0	MCR-13-006_1-18	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B"2. ADJUSTMENT-IND = "0"STEP 3: Type of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "120"STEP 4: Non-missing plan idOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. PLAN-ID-NUMBER is not missingSTEP 5: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 6: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 5, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 7: No managed care participation PCCM planOf the claim lines that meet the criteria from STEP 4, further restrict them by attempting to merge them with the data from STEP 6 and keeping those that satisfy the following criteria:1a. PLAN-ID-NUMBER = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal "02" for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PLAN-ID-NUMBER = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 8: Calculate the percentage for the measureDivide the count of claims from STEP 7 by the count of claims from STEP 4	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP Capitation Payment: Original, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "B"2. ADJUSTMENT-IND = "0"STEP 3: Type of serviceOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "120"STEP 4: Non-missing plan idOf the claims that meet the criteria from STEP 3, further restrict them by the following criteria: 1. PLAN-ID-NUMBER is not missingSTEP 5: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 6: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 5, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 7: No managed care participation PCCM planOf the claim lines that meet the criteria from STEP 4, further restrict them by attempting to merge them with the data from STEP 6 and keeping those that satisfy the following criteria:1a. PLAN-ID-NUMBER = MANAGED-CARE-PLAN-ID2a. MSIS-IDENTIFICATION-NUM matches 3a. MANAGED-CARE-PLAN-TYPE does NOT equal "02" or "03" for any records where 1a and 2a are satisfiedORIt is not the case that:1b. PLAN-ID-NUMBER = MANAGED-CARE-PLAN-ID2b. MSIS-IDENTIFICATION-NUM matches STEP 8: Calculate the percentage for the measureDivide the count of claims from STEP 7 by the count of claims from STEP 4
09/06/2023	3.12.0	MCR-10-024-2	UPDATE	Specification	STEP 1: Active non-duplicated claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. OT-RX-CLAIM-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.	STEP 1: Active non-duplicated OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Drugs, services, or products rendered is 1Of the records that meet the criteria from STEP 2, count line records with1. OT-RX-CLAIM-QUANTITY-ACTUAL = 1STEP 4 : Calculate percentage for measureDivide the count of line records from STEP 3 by the count of line records from STEP 2.
04/21/2023	3.6.0	FFS-54-004-4	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	FFS-54-003-3	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	FFS-54-002-2	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	FFS-54-001-1	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	FFS-53-004-4	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	FFS-53-004-4	UPDATE	Category	Expenditures	N/A
04/21/2023	3.6.0	FFS-53-004-4	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	FFS-53-004-4	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	FFS-53-004-4	UPDATE	Ta min	0
04/21/2023	3.6.0	FFS-53-004-4	UPDATE	Ta max	0.001
04/21/2023	3.6.0	FFS-53-004-4	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: original and adjustment, non-crossover, paid RX claims where Medicare paid amount, total Medicare coinsurance amount, or total Medicare deductible amount is non-zero	N/A
04/21/2023	3.6.0	FFS-53-004-4	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Adjustment, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Non-zero Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1a. MEDICARE-PAID-AMT is non-zero on any lineOR1b. TOT-MEDICARE-COINS-AMT is non-zeroOR 1c. TOT-MEDICARE-DEDUCTIBLE-AMT is non-zeroSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers in STEP 2	N/A
04/21/2023	3.6.0	FFS-53-003-3	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	FFS-53-003-3	UPDATE	Category	Expenditures	N/A
04/21/2023	3.6.0	FFS-53-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	FFS-53-003-3	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	FFS-53-003-3	UPDATE	Ta min	0
04/21/2023	3.6.0	FFS-53-003-3	UPDATE	Ta max	0.001
04/21/2023	3.6.0	FFS-53-003-3	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: original and adjustment, non-crossover, paid OT claims where Medicare paid amount, total Medicare coinsurance amount, or total Medicare deductible amount is non-zero	N/A
04/21/2023	3.6.0	FFS-53-003-3	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers: 1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Adjustment, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Non-zero Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1a. MEDICARE-PAID-AMT is non-zero on any lineOR1b. TOT-MEDICARE-COINS-AMT is non-zeroOR 1c. TOT-MEDICARE-DEDUCTIBLE-AMT is non-zeroSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers in STEP 2	N/A
04/21/2023	3.6.0	FFS-53-002-2	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	FFS-53-002-2	UPDATE	Category	Expenditures	N/A
04/21/2023	3.6.0	FFS-53-002-2	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	FFS-53-002-2	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	FFS-53-002-2	UPDATE	Ta min	0
04/21/2023	3.6.0	FFS-53-002-2	UPDATE	Ta max	0.001
04/21/2023	3.6.0	FFS-53-002-2	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: original and adjustment, non-crossover, paid LT claims where Medicare paid amount, total Medicare coinsurance amount, or total Medicare deductible amount is non-zero	N/A
04/21/2023	3.6.0	FFS-53-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Adjustment, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. CROSSOVER-INDICATOR = "0 or is missingSTEP 3: Non-zero Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1a. MEDICARE-PAID-AMT is non-zeroOR1b. TOT-MEDICARE-COINS-AMT is non-zeroOR 1c. TOT-MEDICARE-DEDUCTIBLE-AMT is non-zeroSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers in STEP 2	N/A
04/21/2023	3.6.0	FFS-53-001-1	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	FFS-53-001-1	UPDATE	Category	Expenditures	N/A
04/21/2023	3.6.0	FFS-53-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	FFS-53-001-1	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	FFS-53-001-1	UPDATE	Ta min	0
04/21/2023	3.6.0	FFS-53-001-1	UPDATE	Ta max	0.001
04/21/2023	3.6.0	FFS-53-001-1	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: original and adjustment, non-crossover paid IP claims where Medicare paid amount, total Medicare coinsurance amount, or total Medicare deductible amount is non-zero	N/A
04/21/2023	3.6.0	FFS-53-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Adjustment, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Non-zero Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1a. MEDICARE-PAID-AMT is non-zeroOR1b. TOT-MEDICARE-COINS-AMT is non-zeroOR 1c. TOT-MEDICARE-DEDUCTIBLE-AMT is non-zeroSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers in STEP 2	N/A
09/06/2023	3.12.0	FFS-50-005-5	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Non-missing billing provider NPI numberOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMOR1b. BILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid FFS: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"STEP 3: Non-missing billing provider NPI numberOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-NPI-NUMSTEP 4: Calculate Luhn check digitOf the claims that meet the criteria from STEP 3, follow the steps below to calculate the Luhn check digit: 1. Ensure that BILLING-PROV-NPI-NUM only contains digits 0-9.2. Ensure that BILLING-PROV-NPI-NUM has length 10.3. Using BILLING-PROV-NPI-NUM, double the digits in slots 1, 3, 5, 7, and 9. 4. If the doubling of the digits results in a number that is greater than or equal to 10, split the digits. For example, 14 becomes 1 and 4. 5. Add the digits from step 4 to the digits in slots 2, 4, 6, and 8.6. Add 24 to the sum from step 5. 7. Round the result from step 6 up to the nearest 10s place.8. Subtract the result from step 6 from the result in step 7.Example: Billing Provider NPI Num = 12345678931. Passes check2. Passes check3. Double odd-slotted digits: 2 6 10 14 18 4. Split digits 10 and over: 2 6 1 0 1 4 1 85. Add digits from above and even-slotted digits: 2 + 6 + 1 + 0 + 1 + 4 + 1 + 8 + 2 + 4 + 6 + 8 = 43. 6. Add 24: 24 + 43 = 67 7. Round up: 67 rounds up to 708. Subtract: 70 - 67 = 3STEP 5: Invalid billing provider NPI numberOf the claims that meet the criteria from STEP 4, keep those that meet the following criteria: 1a. Luhn check digit from STEP 4 does not equal 10th digit of BILLING-PROV-NPI-NUMOR1b. BILLING-PROV-NPI-NUM does not begin with “1”STEP 6: Calculate percentDivide the count from STEP 5 from STEP 3
09/06/2023	3.12.0	FFS-49-004-16	UPDATE	Specification	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Exclude childless headersOf the claim headers that meet the criteria from STEP 2, drop all headers that do not merge to at least one lineSTEP 4: Claims paid at the line levelOf claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 2, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 6: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 5 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 7: Calculate the percentage for the measureDivide the count of header claims from STEP 6 by the count of header claims from STEP 4	STEP 1: Active non-duplicate paid RX claims during report monthDefine the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Exclude childless headersOf the claim headers that meet the criteria from STEP 2, drop all headers that do not merge to at least one lineSTEP 4: Claims paid at the line levelOf claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 4, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 6: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 5 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 7: Calculate the percentage for the measureDivide the count of header claims from STEP 6 by the count of header claims from STEP 4
09/06/2023	3.12.0	FFS-49-003-15	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Exclude childless headersOf the claim headers that meet the criteria from STEP 2, drop all headers that do not merge to at least one lineSTEP 4: Claims paid at the line levelOf claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 2, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 6: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 5 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 7: Calculate the percentage for the measureDivide the count of header claims from STEP 6 by the count of header claims from STEP 4	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Exclude childless headersOf the claim headers that meet the criteria from STEP 2, drop all headers that do not merge to at least one lineSTEP 4: Claims paid at the line levelOf claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 4, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 6: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 5 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 7: Calculate the percentage for the measureDivide the count of header claims from STEP 6 by the count of header claims from STEP 4
09/06/2023	3.12.0	FFS-49-002-14	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Exclude childless headersOf the claim headers that meet the criteria from STEP 2, drop all headers that do not merge to at least one lineSTEP 4: Claims paid at the line levelOf claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 2, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 6: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 5 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 7: Calculate the percentage for the measureDivide the count of header claims from STEP 6 by the count of header claims from STEP 4	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Exclude childless headersOf the claim headers that meet the criteria from STEP 2, drop all headers that do not merge to at least one lineSTEP 4: Claims paid at the line levelOf claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 4, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 6: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 5 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 7: Calculate the percentage for the measureDivide the count of header claims from STEP 6 by the count of header claims from STEP 4
01/27/2023	3.2.0	FFS-49-001-13	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Exclude childless headersOf the claim headers that meet the criteria from STEP 2, drop all headers that do not merge to at least one lineSTEP 4: Claims paid at the line levelOf claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 2, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 6: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 5 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 7: Calculate the percentage for the measureDivide the count of header claims from STEP 6 by the count of header claims from STEP 4	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" STEP 3: Exclude childless headersOf the claim headers that meet the criteria from STEP 2, drop all headers that do not merge to at least one lineSTEP 4: Claims paid at the line levelOf claims that meet the criteria from STEP 3, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 5: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 4, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 6: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 5 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 7: Calculate the percentage for the measureDivide the count of header claims from STEP 6 by the count of header claims from STEP 4
04/21/2023	3.6.0	EXP-42-001-1	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate percentageDivide the number of claims from STEP 3 by the number of claims from STEP 2	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3.
04/21/2023	3.6.0	EXP-41-001-1	UPDATE	Specification	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Total Medicaid paid $0 or missingOf the claims from STEP 2, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate RX records during DQ report monthDefine the RX claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims from STEP 3, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3.
04/21/2023	3.6.0	EXP-40-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate percentageDivide the number of claims from STEP 3 by the number of claims from STEP 2	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3.
03/10/2023	3.4.0	EXP-39-001-1	UPDATE	Priority	High	N/A
03/10/2023	3.4.0	EXP-39-001-1	UPDATE	Category	Expenditures	N/A
03/10/2023	3.4.0	EXP-39-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
03/10/2023	3.4.0	EXP-39-001-1	UPDATE	For ta inferential	Yes	No
03/10/2023	3.4.0	EXP-39-001-1	UPDATE	Ta min	0
03/10/2023	3.4.0	EXP-39-001-1	UPDATE	Ta max	0.1
03/10/2023	3.4.0	EXP-39-001-1	UPDATE	Longitudinal threshold	0.15	N/A
03/10/2023	3.4.0	EXP-39-001-1	UPDATE	Annotation	Calculate the percentage of S-CHIP Encounter: original, non-crossover, paid OT claims where Medicaid paid amount is equal to $0 or missing	N/A
03/10/2023	3.4.0	EXP-39-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, restrict to claims that meet the following criteria:1a. MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate percentageDivide the number of claims from STEP 3 by the number of claims from STEP 2.	N/A
04/21/2023	3.6.0	EXP-38-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Total Medicaid paid $0 or missingOf the claims from STEP 2, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims from STEP 3, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3.
03/10/2023	3.4.0	EXP-37-001-1	UPDATE	Priority	High	N/A
03/10/2023	3.4.0	EXP-37-001-1	UPDATE	Category	Expenditures	N/A
03/10/2023	3.4.0	EXP-37-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
03/10/2023	3.4.0	EXP-37-001-1	UPDATE	For ta inferential	Yes	No
03/10/2023	3.4.0	EXP-37-001-1	UPDATE	Ta min	0
03/10/2023	3.4.0	EXP-37-001-1	UPDATE	Ta max	0.1
03/10/2023	3.4.0	EXP-37-001-1	UPDATE	Longitudinal threshold	0.15	N/A
03/10/2023	3.4.0	EXP-37-001-1	UPDATE	Annotation	The percentage of Medicaid Encounter: original, non-crossover, paid OT claim lines that have Medicaid paid amount equal to $0 or missing	N/A
03/10/2023	3.4.0	EXP-37-001-1	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Medicaid paid $0 or missingOf the claims from STEP 2, select records where:1. MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of claim lines from STEP 3 by the count of claims lines from STEP 2	N/A
04/21/2023	3.6.0	EXP-36-001-1	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate percentageDivide the number of claims from STEP 3 by the number of claims from STEP 2.	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3.
04/21/2023	3.6.0	EXP-35-001-1	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate percentageDivide the number of claims from STEP 3 by the number of claims from STEP 2.	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3.
04/21/2023	3.6.0	EXP-34-001-1	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Total Medicaid paid $0 or missingOf the claims from STEP 2, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims from STEP 3, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3.
04/21/2023	3.6.0	EXP-33-001-1	UPDATE	Specification	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Total Medicaid paid $0 or missingOf the claims from STEP 2, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate LT records during DQ report monthDefine the LT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims from STEP 3, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3.
04/21/2023	3.6.0	EXP-32-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate percentageDivide the number of claims from STEP 3 by the number of claims from STEP 2.	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3.
04/21/2023	3.6.0	EXP-31-001-1	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate percentageDivide the number of claims from STEP 3 by the number of claims from STEP 2.	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: S-CHIP Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 3, restrict to claims that meet the following criteria:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3.
04/21/2023	3.6.0	EXP-30-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Total Medicaid paid $0 or missingOf the claims from STEP 2, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "1"STEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims from STEP 3, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
04/21/2023	3.6.0	EXP-29-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Total Medicaid paid $0 or missingOf the claims from STEP 2, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Total Medicaid paid $0 or missingOf the claims from STEP 3, select records where:1. TOT-MEDICAID-PAID-AMT = "0" or is missingSTEP 5: Calculate the percentage for the measureDivide the count of claims from STEP 4 by the count of claims from STEP 3
06/02/2023	3.8.0	EXP-13-004-2	UPDATE	Priority	High	N/A
06/02/2023	3.8.0	EXP-13-004-2	UPDATE	For ta comprehensive	TA- Inferential	No
06/02/2023	3.8.0	EXP-13-004-2	UPDATE	For ta inferential	Yes	No
06/02/2023	3.8.0	EXP-13-004-2	UPDATE	Annotation	Calculate the percentage of S-CHIP FFS: original, non-crossover, paid OT claims where Medicaid paid amount is equal to $0 or missing	N/A
06/02/2023	3.8.0	EXP-13-004-2	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: S-CHIP FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "A"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, restrict to claims that meet the following criteria:1. MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate percentageDivide the number of claims from STEP 3 by the number of claims from STEP 2.	N/A
03/10/2023	3.4.0	EXP-11-161-2	UPDATE	Priority	High	N/A
03/10/2023	3.4.0	EXP-11-161-2	UPDATE	Category	Expenditures	N/A
03/10/2023	3.4.0	EXP-11-161-2	UPDATE	For ta comprehensive	TA- Inferential	No
03/10/2023	3.4.0	EXP-11-161-2	UPDATE	For ta inferential	Yes	No
03/10/2023	3.4.0	EXP-11-161-2	UPDATE	Ta min	0
03/10/2023	3.4.0	EXP-11-161-2	UPDATE	Ta max	0.1
03/10/2023	3.4.0	EXP-11-161-2	UPDATE	Longitudinal threshold	0.15	N/A
03/10/2023	3.4.0	EXP-11-161-2	UPDATE	Annotation	The percentage of Medicaid FFS: original, non-crossover, paid OT claim lines that have Medicaid paid amount equal to $0 or missing	N/A
03/10/2023	3.4.0	EXP-11-161-2	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Medicaid paid $0 or missingOf the claims that meet the criteria from STEP 2, select records with 1. MEDICAID-PAID-AMT = "0" or is missingSTEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
03/10/2023	3.4.0	EXP-11-160-1	UPDATE	Priority	Medium	N/A
03/10/2023	3.4.0	EXP-11-160-1	UPDATE	Category	Expenditures	N/A
03/10/2023	3.4.0	EXP-11-160-1	UPDATE	For ta comprehensive	TA- Inferential	No
03/10/2023	3.4.0	EXP-11-160-1	UPDATE	For ta inferential	Yes	No
03/10/2023	3.4.0	EXP-11-160-1	UPDATE	Ta min	0
03/10/2023	3.4.0	EXP-11-160-1	UPDATE	Ta max	0.1
03/10/2023	3.4.0	EXP-11-160-1	UPDATE	Longitudinal threshold	0.15	N/A
03/10/2023	3.4.0	EXP-11-160-1	UPDATE	Annotation	Calculate the percentage of Medicaid FFS: original, non-crossover, paid OT claims where the total amount billed is $0	N/A
03/10/2023	3.4.0	EXP-11-160-1	UPDATE	Specification	STEP 1: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid FFS: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1"2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Medicaid billed $0Of the claims that meet the criteria from STEP 2, count records with1. TOT-BILLED-AMT = "0"STEP 4: Calculate the percentage for the measureDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
01/27/2023	3.2.0	EL-S-003-3	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Non-missing raceOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. RACE is non-missingSTEP 4: Percent race for the current month1. For each distinct value of race, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Set the total number of unique MSIS IDs across all valid values of race as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3. 3. For each distinct value of race, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count. STEP 5: Percent race for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of race, set the percent of race for the previous month as Percent_Prior_Month_1.	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHICS-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: CHIPOf the MSIS IDs which meet the criteria from STEP 2, restrict to:1. CHIP-CODE = "2" or "3"STEP 4: Count unique MSIS IDsCount the number of unique MSIS IDs from STEP 3
01/27/2023	3.2.0	EL-6-029-29	UPDATE	Priority	High	N/A
01/27/2023	3.2.0	EL-6-029-29	UPDATE	Category	Program participation	N/A
01/27/2023	3.2.0	EL-6-029-29	UPDATE	For ta comprehensive	TA- Inferential	No
01/27/2023	3.2.0	EL-6-029-29	UPDATE	For ta inferential	Yes	No
01/27/2023	3.2.0	EL-6-029-29	UPDATE	Ta min	0
01/27/2023	3.2.0	EL-6-029-29	UPDATE	Ta max	0.01
01/27/2023	3.2.0	EL-6-028-28	UPDATE	Priority	High	N/A
01/27/2023	3.2.0	EL-6-028-28	UPDATE	Category	Program participation	N/A
01/27/2023	3.2.0	EL-6-028-28	UPDATE	For ta comprehensive	TA- Inferential	No
01/27/2023	3.2.0	EL-6-028-28	UPDATE	For ta inferential	Yes	No
01/27/2023	3.2.0	EL-6-028-28	UPDATE	Ta min	0
01/27/2023	3.2.0	EL-6-028-28	UPDATE	Ta max	0.01
09/06/2023	3.12.0	EL-6-027-27	UPDATE	Measure name	% of partial duals (DUAL-ELIGIBLE-CODE = 01, 03, 05, 06) without an RBC of dual (RESTRICTED-BENEFITS-CODE not 3)	% of partial duals (DUAL-ELIGIBLE-CODE = 01, 03, 05, 06) without an RBC of dual (RESTRICTED-BENEFITS-CODE not 3 or G)
09/06/2023	3.12.0	EL-6-027-27	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Partial dualsOf the MSIS IDs which meet the criteria from STEP 2, restrict to those with a partial dual indicated in their dual eligible code :1. DUAL-ELIGIBLE-CODE = ("01" or "03" or "05" or "06")STEP 4: Not restricted benefit dualsOf the MSIS IDs that meet the criteria from STEP 3, further refine the population that satisfy the following criteria:1. RESTRICTED-BENEFITS-CODE is not equal to "3" or is missingSTEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Partial dualsOf the MSIS IDs which meet the criteria from STEP 2, restrict to those with a partial dual indicated in their dual eligible code :1. DUAL-ELIGIBLE-CODE = ("01" or "03" or "05" or "06")STEP 4: Not restricted benefit dualsOf the MSIS IDs that meet the criteria from STEP 3, further refine the population that satisfy the following criteria:1. RESTRICTED-BENEFITS-CODE is not equal to "3" or "G" or is missingSTEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3
09/06/2023	3.12.0	EL-6-026-26	UPDATE	Measure name	% of RBC duals (RESTRICTED-BENEFITS-CODE = 3) without a partial dual code (DUAL-ELIGIBLE-CODE not 01, 03, 05, 06)	% of RBC duals (RESTRICTED-BENEFITS-CODE = 3 or G) without a partial dual code (DUAL-ELIGIBLE-CODE not 01, 03, 05, 06)
09/06/2023	3.12.0	EL-6-026-26	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Restricted benefit dualsOf the MSIS IDs which meet the criteria from STEP 2, restrict to those that are RBC duals:1. RESTRICTED-BENEFITS-CODE = "3"STEP 4: No partial dual codeOf the MSIS IDs that meet the criteria from STEP 3, further refine the population that satisfy the following criteria:1. DUAL-ELIGIBLE-CODE is not equal to ("01", "03", "05", "06") or is missingSTEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Restricted benefit dualsOf the MSIS IDs which meet the criteria from STEP 2, restrict to those that are RBC duals:1. RESTRICTED-BENEFITS-CODE = "3" or "G"STEP 4: No partial dual codeOf the MSIS IDs that meet the criteria from STEP 3, further refine the population that satisfy the following criteria:1. DUAL-ELIGIBLE-CODE is not equal to ("01", "03", "05", "06") or is missingSTEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3
09/06/2023	3.12.0	EL-6-025-25	UPDATE	Priority	High	N/A
09/06/2023	3.12.0	EL-6-025-25	UPDATE	Category	Beneficiary eligibility	N/A
09/06/2023	3.12.0	EL-6-025-25	UPDATE	For ta comprehensive	TA- Inferential	No
09/06/2023	3.12.0	EL-6-025-25	UPDATE	For ta inferential	Yes	No
09/06/2023	3.12.0	EL-6-025-25	UPDATE	Ta min	0
09/06/2023	3.12.0	EL-6-025-25	UPDATE	Ta max	0.05
04/21/2023	3.6.0	EL-6-022-22	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	EL-6-022-22	UPDATE	Category	Program participation	N/A
04/21/2023	3.6.0	EL-6-022-22	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	EL-6-022-22	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	EL-6-022-22	UPDATE	Ta min	0.9
04/21/2023	3.6.0	EL-6-022-22	UPDATE	Ta max	1
04/21/2023	3.6.0	EL-6-022-22	UPDATE	Annotation	Calculate the percentage of Family Planning waiver eligibles with restricted benefit code equal to 6	N/A
04/21/2023	3.6.0	EL-6-022-22	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Waiver participation on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment WAIVER-PARTICIPATION-ELG00012 by keeping records that satisfy the following criteria:1a. WAIVER-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. WAIVER-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. WAIVER-ENROLLMENT-EFF-DATE is missing2b. WAIVER-ENROLLMENT-END-DATE is missingSTEP 3: Family planning waiver participantsOf the MSIS IDs that meet the criteria from STEP 2, select family planning waiver participants:1. WAIVER-TYPE = "24"2. Remove any duplicates, so each MSIS ID only appears once.STEP 4: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 5: Restricted benefits codeOf the MSIS IDs which meet the criteria from STEP 4, restrict to:1. RESTRICTED-BENEFITS-CODE = "6"STEP 6: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 5 by the count of MSIS IDs from STEP 3.	N/A
03/10/2023	3.4.0	EL-3-025-30	UPDATE	Annotation	Count the number of mandatory eligibility groups for SSI or ABD individuals with at least one MSIS ID with a primarily eligibility group indicator associated with it	N/A
03/10/2023	3.4.0	EL-3-025-30	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Frequency of mandatory eligibility groupsOf the MSIS IDs that meet the criteria from STEP 2, count the number of unique MSIS IDs where ELIGIBILITY-GROUP is equal to each of the following values: 11, 12STEP 4: Count of categoriesOf the 2 mandatory eligibility group categories referenced in STEP 3, count the number of categories with at least one MSIS ID	N/A
03/10/2023	3.4.0	EL-3-017-22	UPDATE	Annotation	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "72" for states NOT expected to report this value according to MBES enrollment data	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "72" for states NOT expected to report this value according to public MBES enrollment data on Medicaid.gov
03/10/2023	3.4.0	EL-3-017-22	UPDATE	Specification	STEP 1: Measure applies to submitting state1a. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "72" because there are NO enrollees in the “VIII group eligible” category in the MBES enrollment data, proceed to STEP 2ELSE1b. If submitting state is expected to report ELIGIBILITY-GROUP value "72" because there are enrollees in the “VIII group eligible” category in the MBES enrollment data, the final measure statistic will be displayed as "N/A"STEP 2: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 2, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 4: MSIS IDs with eligibility group 72Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "72"STEP 5: Calculate percentageDivide the count from STEP 4 by the count from STEP 2	STEP 1: Measure applies to submitting state1a. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "72" because there are NO enrollees in the “VIII group eligible” category in the MBES enrollment data, proceed to STEP 2ELSE1b. If submitting state is expected to report ELIGIBILITY-GROUP value "72" because there are enrollees in the “VIII group eligible” category in the public MBES enrollment data on Medicaid.gov, the final measure statistic will be displayed as "N/A"STEP 2: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 2, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 4: MSIS IDs with eligibility group 72Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "72"STEP 5: Calculate percentageDivide the count from STEP 4 by the count from STEP 2
03/10/2023	3.4.0	EL-3-014-19	UPDATE	Annotation	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "72" for states expected to report this value according to MBES enrollment data	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "72" for states expected to report this value according to public MBES enrollment data on Medicaid.gov
03/10/2023	3.4.0	EL-3-014-19	UPDATE	Specification	STEP 1: Measure applies to submitting state1a. If submitting state is expected to report ELIGIBILITY-GROUP value "72" because there are enrollees in the “VIII group eligible” category in the MBES enrollment data, proceed to STEP 2ELSE1b. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "72" because there are NO enrollees in the “VIII group eligible” category in the MBES enrollment data, the final measure statistic will be displayed as "N/A"STEP 2: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 2, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 4: MSIS IDs with eligibility group 72Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "72"STEP 5: Calculate percentageDivide the count from STEP 4 by the count from STEP 2	STEP 1: Measure applies to submitting state1a. If submitting state is expected to report ELIGIBILITY-GROUP value "72" because there are enrollees in the “VIII group eligible” category in the MBES enrollment data, proceed to STEP 2ELSE1b. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "72" because there are NO enrollees in the “VIII group eligible” category in the public MBES enrollment data on Medicaid.gov, the final measure statistic will be displayed as "N/A"STEP 2: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 2, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 4: MSIS IDs with eligibility group 72Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "72"STEP 5: Calculate percentageDivide the count from STEP 4 by the count from STEP 2
01/27/2023	3.2.0	EL-3-001_2-14	UPDATE	Ta min	0
01/27/2023	3.2.0	EL-3-001_2-14	UPDATE	Ta max	0.001
12/09/2022	3.0.6	EL-19-001-1	UPDATE	Specification	STEP 1: Enrolled any day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= first day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Enrolled any day of prior DQ report monthDefine the prior eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the prior DQ report month 2. ENROLLMENT-END-DATE >= first day of the prior DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Enrolled in prior month but not current monthKeep all MSIS IDs from STEP 2 that are NOT in STEP 1STEP 4: Eligibility determinants any day of prior DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the prior DQ report month3. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the prior DQ report month OR missing*Note: If multiple segments meet the criteria for one MSIS ID, keep latest one (sort by max end date, max effective date, min record byte offset)STEP 5: Valid, known eligibility change reasonOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with: 1. ELIGIBILITY-CHANGE-REASON = (“01”,“02”,“03”,“04”,“05”, “06”,”07”,“08”,“09”,“10”,“11”,“12”, “13”,“14”,“15”,“16”,“17”, “18”,“19”, or “20”)STEP 6: Missing, invalid, unknown, or other eligibility change reasonKeep all MSIS IDs from STEP 3 that are NOT in STEP 5STEP 7: Calculate percentageDivide the unique count of MSIS IDs from STEP 6 by the unique count of MSIS IDs from STEP 3	STEP 1: Enrolled any day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= first day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Enrolled any day of prior DQ report monthDefine the prior eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the prior DQ report month 2. ENROLLMENT-END-DATE >= first day of the prior DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Enrolled in prior month but not current monthKeep all MSIS IDs from STEP 2 that are NOT in STEP 1STEP 4: Eligibility determinants any day of prior DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the prior DQ report month3. ELIGIBILITY-DETERMINANT-END-DATE >= first day of the prior DQ report month OR missing*Note: If multiple segments meet the criteria for one MSIS ID, keep latest one (sort by max end date, max effective date, min record byte offset)STEP 5: Valid, known eligibility change reasonOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with: 1. ELIGIBILITY-CHANGE-REASON = (“01”,“02”,“03”,“04”,“05”, “06”,”07”,“08”,“09”,“10”,“11”,“12”, “13”,“14”,“15”,“16”,“17”, “18”,“19”, or “20”)STEP 6: Missing, invalid, unknown, or other eligibility change reasonKeep all MSIS IDs from STEP 3 that are NOT in STEP 5STEP 7: Calculate percentageDivide the unique count of MSIS IDs from STEP 6 by the unique count of MSIS IDs from STEP 3
04/21/2023	3.6.0	EL-17-003-3	UPDATE	Priority	Critical	N/A
04/21/2023	3.6.0	EL-17-003-3	UPDATE	Category	File integrity	N/A
04/21/2023	3.6.0	EL-17-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	EL-17-003-3	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	EL-17-003-3	UPDATE	Ta min	0
04/21/2023	3.6.0	EL-17-003-3	UPDATE	Ta max	0.001
04/21/2023	3.6.0	EL-17-003-3	UPDATE	Annotation	Calculate the percentage of eligibles on the enrollment time span segment who are not present on the eligibility determinants segment in the same month	N/A
04/21/2023	3.6.0	EL-17-003-3	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population using segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missing.STEP 2: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Do not link to eligibility determinantsRefine the population to MSIS IDs on the enrollment time span segment from STEP 1 that could NOT be linked to a eligibility determinants segment from STEP 2STEP 4: Calculate percentageDivide the count of unique MSIS IDs from STEP 3 by the count of unique MSIS IDs from STEP 1	N/A
04/21/2023	3.6.0	EL-17-002-2	UPDATE	Priority	Critical	N/A
04/21/2023	3.6.0	EL-17-002-2	UPDATE	Category	File integrity	N/A
04/21/2023	3.6.0	EL-17-002-2	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	EL-17-002-2	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	EL-17-002-2	UPDATE	Ta min	0
04/21/2023	3.6.0	EL-17-002-2	UPDATE	Ta max	0.001
04/21/2023	3.6.0	EL-17-002-2	UPDATE	Annotation	Calculate the percentage of eligibles on the enrollment time span segment who are not present on the variable demographics segment in the same month	N/A
04/21/2023	3.6.0	EL-17-002-2	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population using segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missing.STEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Do not link to variable demographicsRefine the population to MSIS IDs on the enrollment time span segment from STEP 1 that could NOT be linked to a variable demographics segment from STEP 2STEP 4: Calculate percentageDivide the count of unique MSIS IDs from STEP 3 by the count of unique MSIS IDs from STEP 1	N/A
04/21/2023	3.6.0	EL-17-001-1	UPDATE	Priority	Critical	N/A
04/21/2023	3.6.0	EL-17-001-1	UPDATE	Category	File integrity	N/A
04/21/2023	3.6.0	EL-17-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	EL-17-001-1	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	EL-17-001-1	UPDATE	Ta min	0
04/21/2023	3.6.0	EL-17-001-1	UPDATE	Ta max	0.001
04/21/2023	3.6.0	EL-17-001-1	UPDATE	Annotation	Calculate the percentage of eligibles on the enrollment time span segment who are not present on the primary demographics segment in the same month	N/A
04/21/2023	3.6.0	EL-17-001-1	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population using segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missing.STEP 2: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Do not link to primary demographicsRefine the population to MSIS IDs on the enrollment time span segment from STEP 1 that could NOT be linked to a primary demographics segment from STEP 2STEP 4: Calculate percentageDivide the count of unique MSIS IDs from STEP 3 by the count of unique MSIS IDs from STEP 1	N/A
06/02/2023	3.8.0	EL-16-009-9	UPDATE	Priority	Critical	N/A
06/02/2023	3.8.0	EL-16-009-9	UPDATE	Category	File integrity	N/A
06/02/2023	3.8.0	EL-16-009-9	UPDATE	For ta comprehensive	TA- Inferential	No
06/02/2023	3.8.0	EL-16-009-9	UPDATE	For ta inferential	Yes	No
06/02/2023	3.8.0	EL-16-009-9	UPDATE	Ta min	0
06/02/2023	3.8.0	EL-16-009-9	UPDATE	Ta max	0.001
06/02/2023	3.8.0	EL-16-009-9	UPDATE	Annotation	Calculate the percentage of rows in the ELG00021 segment which are missing an MSIS ID number	N/A
06/02/2023	3.8.0	EL-16-009-9	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment ENROLLMENT-TIME-SPAN-ELG00021 STEP 2: Total number of rowsCount the number of rows in the ELG00021 segment. STEP 3: Missing MSIS IDOf the rows from STEP 2, restrict to those where MSIS-IDENTIFICATION-NUM is missing.STEP 4: Calculate percentageDivide the count of rows from STEP 3 by the count of rows from STEP 2.	N/A
06/02/2023	3.8.0	EL-16-008-8	UPDATE	Priority	Critical	N/A
06/02/2023	3.8.0	EL-16-008-8	UPDATE	Category	File integrity	N/A
06/02/2023	3.8.0	EL-16-008-8	UPDATE	For ta comprehensive	TA- Inferential	No
06/02/2023	3.8.0	EL-16-008-8	UPDATE	For ta inferential	Yes	No
06/02/2023	3.8.0	EL-16-008-8	UPDATE	Ta min	0
06/02/2023	3.8.0	EL-16-008-8	UPDATE	Ta max	0.001
06/02/2023	3.8.0	EL-16-008-8	UPDATE	Annotation	Calculate the percentage of rows in the ELG00016 segment which are missing an MSIS ID number	N/A
06/02/2023	3.8.0	EL-16-008-8	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment RACE-INFORMATION-ELG00016STEP 2: Total number of rowsCount the number of rows in the ELG00016 segment. STEP 3: Missing MSIS IDOf the rows from STEP 2, restrict to those where MSIS-IDENTIFICATION-NUM is missing.STEP 4: Calculate percentageDivide the count of rows from STEP 3 by the count of rows from STEP 2.	N/A
06/02/2023	3.8.0	EL-16-007-7	UPDATE	Priority	Critical	N/A
06/02/2023	3.8.0	EL-16-007-7	UPDATE	Category	File integrity	N/A
06/02/2023	3.8.0	EL-16-007-7	UPDATE	For ta comprehensive	TA- Inferential	No
06/02/2023	3.8.0	EL-16-007-7	UPDATE	For ta inferential	Yes	No
06/02/2023	3.8.0	EL-16-007-7	UPDATE	Ta min	0
06/02/2023	3.8.0	EL-16-007-7	UPDATE	Ta max	0.001
06/02/2023	3.8.0	EL-16-007-7	UPDATE	Annotation	Calculate the percentage of rows in the ELG00015 segment which are missing an MSIS ID number	N/A
06/02/2023	3.8.0	EL-16-007-7	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment ETHNICITY-INFORMATION-ELG00015STEP 2: Total number of rowsCount the number of rows in the ELG00015 segment. STEP 3: Missing MSIS IDOf the rows from STEP 2, restrict to those where MSIS-IDENTIFICATION-NUM is missing.STEP 4: Calculate percentageDivide the count of rows from STEP 3 by the count of rows from STEP 2.	N/A
06/02/2023	3.8.0	EL-16-006-6	UPDATE	Priority	Critical	N/A
06/02/2023	3.8.0	EL-16-006-6	UPDATE	Category	File integrity	N/A
06/02/2023	3.8.0	EL-16-006-6	UPDATE	For ta comprehensive	TA- Inferential	No
06/02/2023	3.8.0	EL-16-006-6	UPDATE	For ta inferential	Yes	No
06/02/2023	3.8.0	EL-16-006-6	UPDATE	Ta min	0
06/02/2023	3.8.0	EL-16-006-6	UPDATE	Ta max	0.001
06/02/2023	3.8.0	EL-16-006-6	UPDATE	Annotation	Calculate the percentage of rows in the ELG00014 segment which are missing an MSIS ID number	N/A
06/02/2023	3.8.0	EL-16-006-6	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment MANAGED-CARE-PARTICIPATION-ELG00014STEP 2: Total number of rowsCount the number of rows in the ELG00014 segment. STEP 3: Missing MSIS IDOf the rows from STEP 2, restrict to those where MSIS-IDENTIFICATION-NUM is missing.STEP 4: Calculate percentageDivide the count of rows from STEP 3 by the count of rows from STEP 2.	N/A
06/02/2023	3.8.0	EL-16-005-5	UPDATE	Priority	Critical	N/A
06/02/2023	3.8.0	EL-16-005-5	UPDATE	Category	File integrity	N/A
06/02/2023	3.8.0	EL-16-005-5	UPDATE	For ta comprehensive	TA- Inferential	No
06/02/2023	3.8.0	EL-16-005-5	UPDATE	For ta inferential	Yes	No
06/02/2023	3.8.0	EL-16-005-5	UPDATE	Ta min	0
06/02/2023	3.8.0	EL-16-005-5	UPDATE	Ta max	0.001
06/02/2023	3.8.0	EL-16-005-5	UPDATE	Annotation	Calculate the percentage of rows in the ELG00012 segment which are missing an MSIS ID number	N/A
06/02/2023	3.8.0	EL-16-005-5	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment WAIVER-PARTICIPATION-ELG00012STEP 2: Total number of rowsCount the number of rows in the ELG00012 segment. STEP 3: Missing MSIS IDOf the rows from STEP 2, restrict to those where MSIS-IDENTIFICATION-NUM is missing.STEP 4: Calculate percentageDivide the count of rows from STEP 3 by the count of rows from STEP 2.	N/A
06/02/2023	3.8.0	EL-16-004-4	UPDATE	Priority	Critical	N/A
06/02/2023	3.8.0	EL-16-004-4	UPDATE	Category	File integrity	N/A
06/02/2023	3.8.0	EL-16-004-4	UPDATE	For ta comprehensive	TA- Inferential	No
06/02/2023	3.8.0	EL-16-004-4	UPDATE	For ta inferential	Yes	No
06/02/2023	3.8.0	EL-16-004-4	UPDATE	Ta min	0
06/02/2023	3.8.0	EL-16-004-4	UPDATE	Ta max	0.001
06/02/2023	3.8.0	EL-16-004-4	UPDATE	Annotation	Calculate the percentage of rows in the ELG00005 segment which are missing an MSIS ID number	N/A
06/02/2023	3.8.0	EL-16-004-4	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment ELIGIBILITY-DETERMINANTS-ELG00005STEP 2: Total number of rowsCount the number of rows in the ELG00005 segment. STEP 3: Missing MSIS IDOf the rows from STEP 2, restrict to those where MSIS-IDENTIFICATION-NUM is missing.STEP 4: Calculate percentageDivide the count of rows from STEP 3 by the count of rows from STEP 2.	N/A
06/02/2023	3.8.0	EL-16-003-3	UPDATE	Priority	Critical	N/A
06/02/2023	3.8.0	EL-16-003-3	UPDATE	Category	File integrity	N/A
06/02/2023	3.8.0	EL-16-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
06/02/2023	3.8.0	EL-16-003-3	UPDATE	For ta inferential	Yes	No
06/02/2023	3.8.0	EL-16-003-3	UPDATE	Ta min	0
06/02/2023	3.8.0	EL-16-003-3	UPDATE	Ta max	0.001
06/02/2023	3.8.0	EL-16-003-3	UPDATE	Annotation	Calculate the percentage of rows in the ELG00004 segment which are missing an MSIS ID number	N/A
06/02/2023	3.8.0	EL-16-003-3	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment ELIGIBLE-CONTACT-INFORMATION-ELG00004STEP 2: Total number of rowsCount the number of rows in the ELG00004 segment. STEP 3: Missing MSIS IDOf the rows from STEP 2, restrict to those where MSIS-IDENTIFICATION-NUM is missing.STEP 4: Calculate percentageDivide the count of rows from STEP 3 by the count of rows from STEP 2.	N/A
06/02/2023	3.8.0	EL-16-002-2	UPDATE	Priority	Critical	N/A
06/02/2023	3.8.0	EL-16-002-2	UPDATE	Category	File integrity	N/A
06/02/2023	3.8.0	EL-16-002-2	UPDATE	For ta comprehensive	TA- Inferential	No
06/02/2023	3.8.0	EL-16-002-2	UPDATE	For ta inferential	Yes	No
06/02/2023	3.8.0	EL-16-002-2	UPDATE	Ta min	0
06/02/2023	3.8.0	EL-16-002-2	UPDATE	Ta max	0.001
06/02/2023	3.8.0	EL-16-002-2	UPDATE	Annotation	Calculate the percentage of rows in the ELG00003 segment which are missing an MSIS ID number	N/A
06/02/2023	3.8.0	EL-16-002-2	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment VARIABLE-DEMOGRAPHICS-ELIGIBILITY-ELG00003STEP 2: Total number of rowsCount the number of rows in the ELG00003 segment. STEP 3: Missing MSIS IDOf the rows from STEP 2, restrict to those where MSIS-IDENTIFICATION-NUM is missing.STEP 4: Calculate percentageDivide the count of rows from STEP 3 by the count of rows from STEP 2.	N/A
06/02/2023	3.8.0	EL-16-001-1	UPDATE	Priority	Critical	N/A
06/02/2023	3.8.0	EL-16-001-1	UPDATE	Category	File integrity	N/A
06/02/2023	3.8.0	EL-16-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
06/02/2023	3.8.0	EL-16-001-1	UPDATE	For ta inferential	Yes	No
06/02/2023	3.8.0	EL-16-001-1	UPDATE	Ta min	0
06/02/2023	3.8.0	EL-16-001-1	UPDATE	Ta max	0.001
06/02/2023	3.8.0	EL-16-001-1	UPDATE	Annotation	Calculate the percentage of rows in the ELG00002 segment which are missing an MSIS ID number	N/A
06/02/2023	3.8.0	EL-16-001-1	UPDATE	Specification	STEP 1: Any active record segmentKeep all active records from segment PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002STEP 2: Total number of rowsCount the number of rows in the ELG00002 segment. STEP 3: Missing MSIS IDOf the rows from STEP 2, restrict to those where MSIS-IDENTIFICATION-NUM is missing.STEP 4: Calculate percentageDivide the count of rows from STEP 3 by the count of rows from STEP 2.	N/A
12/09/2022	3.0.6	EL-15-002-2	UPDATE	Ta min	-0.1	-0.05
12/09/2022	3.0.6	EL-15-002-2	UPDATE	Ta max	0.1	0.05
12/09/2022	3.0.6	EL-15-002-2	UPDATE	Threshold minimum	-0.1	-0.05
12/09/2022	3.0.6	EL-15-002-2	UPDATE	Threshold maximum	0.1	0.05
09/06/2023	3.12.0	EL-1-021-21	UPDATE	Priority	High	N/A
09/06/2023	3.12.0	EL-1-021-21	UPDATE	Category	Beneficiary demographics	N/A
09/06/2023	3.12.0	EL-1-021-21	UPDATE	For ta comprehensive	TA- Inferential	No
09/06/2023	3.12.0	EL-1-021-21	UPDATE	For ta inferential	Yes	No
09/06/2023	3.12.0	EL-1-021-21	UPDATE	Ta min	0
09/06/2023	3.12.0	EL-1-021-21	UPDATE	Ta max	0.001
06/02/2023	3.8.0	EL-1-011-10	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Unknown raceOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE-CODE does not equal (“001,” “002,” “003,” “004,” “005,” “006,” “007,” “008,” “009,” “010,” “011,” “012,” “013,” “014,” “015,” “016,” or “018”) or is missingSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Race information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment RACE-INFORMATION-ELG00016 by keeping active records that satisfy the following criteria:1a. RACE-DECLARATION-EFF-DATE <= last day of the DQ report month2a. RACE-DECLARATION-END-DATE >= last day of the DQ report month OR missingOR1b. RACE-DECLARATION-EFF-DATE is missing2b. RACE-DECLARATION-END-DATE is missingSTEP 3: Unknown raceOf the MSIS IDs that meet the criteria from STEP 2, further restrict them by the following criteria:1. RACE does not equal (“001,” “002,” “003,” “004,” “005,” “006,” “007,” “008,” “009,” “010,” “011,” “012,” “013,” “014,” “015,” “016,” or “018”) or is missingSTEP 4: PercentageDivide the count from STEP 3 by the count in STEP 1*Note: This can include MSIS IDs from STEP 1 that did not join to a race information segment.
09/06/2023	3.12.0	EL-1-006-4	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligible contact information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBLE_CONTACT_INFORMATION ELG00004 by keeping records that satisfy the following criteria:1a. ELIGIBLE-ADDR-EFF-DATE <= last day of the DQ report month2a. ELIGIBLE-ADDR-EFF-DATE >= last day of the DQ report month OR missingOR1b. ELIGIBLE-ADDR-EFF-DATE is missing2b. ELIGIBLE-ADDR-EFF-DATE is missingSTEP 3: Non-missing county code for primary addressOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. ELIGIBLE-COUNTY-CODE non-missing2. ELIGIBLE_ADDRESS_TYPE = "01"STEP 4: Percent eligible county code for the current month1. For each distinct value of county code, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Set the total number of unique MSIS IDs across all valid values of county code as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3. 3. For each distinct value of county code, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count.STEP 5: Percent eligible county code for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of county code, set the percent of county code for the previous month as Percent_Prior_Month_1. STEP 6: Calculate change between monthsFor each frequency percent, calculate Frequency_Change as the absolute value of (Percent_Current_Month – Percent_Prior_Month_1) / 2. Note that Frequency_Change is a vector of frequencies.STEP 7: Calculate index of dissimilarityCalculate the index of dissimilarity by summing Frequency_Change across all frequencies and dividing by 100	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligible contact information on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBLE_CONTACT_INFORMATION ELG00004 by keeping records that satisfy the following criteria:1a. ELIGIBLE-ADDR-EFF-DATE <= last day of the DQ report month2a. ELIGIBLE-ADDR-END-DATE >= last day of the DQ report month OR missingOR1b. ELIGIBLE-ADDR-EFF-DATE is missing2b. ELIGIBLE-ADDR-END-DATE is missingSTEP 3: Non-missing county code for primary addressOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with: 1. ELIGIBLE-COUNTY-CODE non-missing2. ELIGIBLE_ADDRESS_TYPE = "01"STEP 4: Percent eligible county code for the current month1. For each distinct value of county code, set the number of unique MSIS IDs as Numerator_Count_By_Value. 2. Set the total number of unique MSIS IDs across all valid values of county code as Denominator_Count. Note that Denominator_Count should also equal to the count of MSIS IDs from STEP 3. 3. For each distinct value of county code, calculate Percent_Current_Month as the ratio of Numerator_Count_By_Value over Denominator_Count.STEP 5: Percent eligible county code for the previous monthRepeat STEP 1 through STEP 4 for the previous month. For each distinct value of county code, set the percent of county code for the previous month as Percent_Prior_Month_1. STEP 6: Calculate change between monthsFor each frequency percent, calculate Frequency_Change as the absolute value of (Percent_Current_Month – Percent_Prior_Month_1) / 2. Note that Frequency_Change is a vector of frequencies.STEP 7: Calculate index of dissimilarityCalculate the index of dissimilarity by summing Frequency_Change across all frequencies and dividing by 100
09/06/2023	3.12.0	EL-10-008-8	UPDATE	Priority	High	N/A
09/06/2023	3.12.0	EL-10-008-8	UPDATE	Category	Program participation	N/A
09/06/2023	3.12.0	EL-10-008-8	UPDATE	For ta comprehensive	TA- Inferential	No
09/06/2023	3.12.0	EL-10-008-8	UPDATE	For ta inferential	Yes	No
09/06/2023	3.12.0	EL-10-008-8	UPDATE	Ta min	0
09/06/2023	3.12.0	EL-10-008-8	UPDATE	Ta max	0.01
09/06/2023	3.12.0	EL-10-007-7	UPDATE	Priority	High	N/A
09/06/2023	3.12.0	EL-10-007-7	UPDATE	Category	Program participation	N/A
09/06/2023	3.12.0	EL-10-007-7	UPDATE	For ta comprehensive	TA- Inferential	No
09/06/2023	3.12.0	EL-10-007-7	UPDATE	For ta inferential	Yes	No
09/06/2023	3.12.0	EL-10-007-7	UPDATE	Ta min	0
09/06/2023	3.12.0	EL-10-007-7	UPDATE	Ta max	0.01
01/27/2023	3.2.0	ALL-21-008-8	UPDATE	Priority	High	N/A
01/27/2023	3.2.0	ALL-21-008-8	UPDATE	Category	Provider enrollment	N/A
01/27/2023	3.2.0	ALL-21-008-8	UPDATE	For ta comprehensive	TA- Inferential	No
01/27/2023	3.2.0	ALL-21-008-8	UPDATE	For ta inferential	Yes	No
01/27/2023	3.2.0	ALL-21-008-8	UPDATE	Ta min	0
01/27/2023	3.2.0	ALL-21-008-8	UPDATE	Ta max	0.05
01/27/2023	3.2.0	ALL-21-007-7	UPDATE	Priority	High	N/A
01/27/2023	3.2.0	ALL-21-007-7	UPDATE	Category	Provider enrollment	N/A
01/27/2023	3.2.0	ALL-21-007-7	UPDATE	For ta comprehensive	TA- Inferential	No
01/27/2023	3.2.0	ALL-21-007-7	UPDATE	For ta inferential	Yes	No
01/27/2023	3.2.0	ALL-21-007-7	UPDATE	Ta min	0
01/27/2023	3.2.0	ALL-21-007-7	UPDATE	Ta max	0.05
01/27/2023	3.2.0	ALL-21-006-6	UPDATE	Priority	High	N/A
01/27/2023	3.2.0	ALL-21-006-6	UPDATE	Category	Provider enrollment	N/A
01/27/2023	3.2.0	ALL-21-006-6	UPDATE	For ta comprehensive	TA- Inferential	No
01/27/2023	3.2.0	ALL-21-006-6	UPDATE	For ta inferential	Yes	No
01/27/2023	3.2.0	ALL-21-006-6	UPDATE	Ta min	0
01/27/2023	3.2.0	ALL-21-006-6	UPDATE	Ta max	0.05
01/27/2023	3.2.0	ALL-21-005-5	UPDATE	Priority	High	N/A
01/27/2023	3.2.0	ALL-21-005-5	UPDATE	Category	Provider enrollment	N/A
01/27/2023	3.2.0	ALL-21-005-5	UPDATE	For ta comprehensive	TA- Inferential	No
01/27/2023	3.2.0	ALL-21-005-5	UPDATE	For ta inferential	Yes	No
01/27/2023	3.2.0	ALL-21-005-5	UPDATE	Ta min	0
01/27/2023	3.2.0	ALL-21-005-5	UPDATE	Ta max	0.05
01/27/2023	3.2.0	ALL-21-004-4	UPDATE	Priority	High	N/A
01/27/2023	3.2.0	ALL-21-004-4	UPDATE	Category	Provider enrollment	N/A
01/27/2023	3.2.0	ALL-21-004-4	UPDATE	For ta comprehensive	TA- Inferential	No
01/27/2023	3.2.0	ALL-21-004-4	UPDATE	For ta inferential	Yes	No
01/27/2023	3.2.0	ALL-21-004-4	UPDATE	Ta min	0
01/27/2023	3.2.0	ALL-21-004-4	UPDATE	Ta max	0.05
01/27/2023	3.2.0	ALL-21-003-3	UPDATE	Priority	High	N/A
01/27/2023	3.2.0	ALL-21-003-3	UPDATE	Category	Provider enrollment	N/A
01/27/2023	3.2.0	ALL-21-003-3	UPDATE	For ta comprehensive	TA- Inferential	No
01/27/2023	3.2.0	ALL-21-003-3	UPDATE	For ta inferential	Yes	No
01/27/2023	3.2.0	ALL-21-003-3	UPDATE	Ta min	0
01/27/2023	3.2.0	ALL-21-003-3	UPDATE	Ta max	0.05
01/27/2023	3.2.0	ALL-21-002-2	UPDATE	Priority	High	N/A
01/27/2023	3.2.0	ALL-21-002-2	UPDATE	Category	Provider enrollment	N/A
01/27/2023	3.2.0	ALL-21-002-2	UPDATE	For ta comprehensive	TA- Inferential	No
01/27/2023	3.2.0	ALL-21-002-2	UPDATE	For ta inferential	Yes	No
01/27/2023	3.2.0	ALL-21-002-2	UPDATE	Ta min	0
01/27/2023	3.2.0	ALL-21-002-2	UPDATE	Ta max	0.05
01/27/2023	3.2.0	ALL-21-001-1	UPDATE	Priority	High	N/A
01/27/2023	3.2.0	ALL-21-001-1	UPDATE	Category	Provider enrollment	N/A
01/27/2023	3.2.0	ALL-21-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
01/27/2023	3.2.0	ALL-21-001-1	UPDATE	For ta inferential	Yes	No
01/27/2023	3.2.0	ALL-21-001-1	UPDATE	Ta min	0
01/27/2023	3.2.0	ALL-21-001-1	UPDATE	Ta max	0.05
06/02/2023	3.8.0	ALL-20-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: STEP 3: Title XIX and Title XXI fundingOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. XIX-MBESCBES-CATEGORY-OF-SERVICE is not missing2. XXI-MBESCBES-CATEGORY-OF-SERVICE is not missingSTEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. No Header Duplicates: Duplicates are dropped at the header level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Title XIX and Title XXI fundingOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. XIX-MBESCBES-CATEGORY-OF-SERVICE is not missing2. XXI-MBESCBES-CATEGORY-OF-SERVICE is not missingSTEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2
01/27/2023	3.2.0	ALL-19-001-1	UPDATE	Priority	High	N/A
01/27/2023	3.2.0	ALL-19-001-1	UPDATE	Category	Utilization	N/A
01/27/2023	3.2.0	ALL-19-001-1	UPDATE	For ta comprehensive	TA- Inferential	No
01/27/2023	3.2.0	ALL-19-001-1	UPDATE	For ta inferential	Yes	No
01/27/2023	3.2.0	ALL-19-001-1	UPDATE	Ta min	0
01/27/2023	3.2.0	ALL-19-001-1	UPDATE	Ta max	0.001
04/21/2023	3.6.0	ALL-13-003-5	UPDATE	Measure name	% alien restricted benefits code status (RESTRICTED-BENEFITS-CODE = 2) with services that are not emergency room or pregnancy-related	% of MSIS IDs with alien restricted benefits code status (RESTRICTED-BENEFITS-CODE = 2) with services that are not emergency room or pregnancy-related
02/18/2025	3.34.0	ENROLLMENT-TIME-SPAN-SEGMENT	UPDATE	Record segment definition	A record to capture the eligible person's type of enrollment and time spans of enrollment."	A record to capture the eligible person's type of enrollment and time spans of enrollment.
02/18/2025	3.34.0	HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME	UPDATE	Record segment definition	A record to capture an eligible person's chronic conditions for which an eligible person is receiving home and community-based care."	A record to capture an eligible person's chronic conditions for which an eligible person is receiving home and community-based care.
02/18/2025	3.34.0	1115A-DEMONSTRATION-INFORMATION	UPDATE	Record segment definition	A record to capture an eligible person's 1115A participation."	A record to capture an eligible person's 1115A participation.
02/18/2025	3.34.0	RACE-INFORMATION	UPDATE	Record segment definition	A record to capture information about an eligible person's race.,1	A record to capture information about an eligible person's race.
03/12/2025	3.35.0	ELIGIBILITY-GROUP (ELG087)	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-GROUP \| 20250301 \| 99991231 \| 77 \| Other optional eligibility for reasonable classifications of children under 21
03/12/2025	3.35.0	ADDR-COUNTY (ELG072)	Delete	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ADDR-COUNTY \| 01/01/0001 \| 12/31/9999 \| 113 \| Shannon County, South Dakota \|	N/A
12/06/2024	3.32.0	RULE-2013	Delete	Data Dictionary - Validation Rules	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.PREGNANCY-IND equals '1', then PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'F''	N/A
12/06/2024	3.32.0	RULE-827	Delete	Data Dictionary - Validation Rules	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' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-IP.XIX-MBESCBES-CATEGORY-OF-SERVICE is not equal to one of the following: '14', '35', '42', '44''	N/A
12/06/2024	3.32.0	RULE-1260	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-LT.XIX-MBESCBES-CATEGORY-OF-SERVICE is not equal to one of the following: '14', '35', '42', '44''	N/A
12/06/2024	3.32.0	RULE-1694	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-OT.XIX-MBESCBES-CATEGORY-OF-SERVICE is not equal to one of the following: '14', '35', '42', '44''	N/A
12/06/2024	3.32.0	RULE-1958	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-RX.XIX-MBESCBES-CATEGORY-OF-SERVICE is not equal to one of the following: '14', '35', '42', '44''	N/A
12/06/2024	3.32.0	RULE-1657	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '025', '085''	N/A
12/06/2024	3.32.0	RULE-808	Delete	Data Dictionary - Validation Rules	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' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE does not equal '086''	N/A
12/06/2024	3.32.0	RULE-1939	Delete	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE does not equal '086''	N/A
12/06/2024	3.32.0	RULE-2155	Delete	Data Dictionary - Validation Rules	if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '4', then PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'F''	N/A
12/06/2024	3.32.0	RULE-7367	Delete	Data Dictionary - Validation Rules	if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM then PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null value for SEX then PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null value for SEX	N/A
11/08/2024	3.31.0	XIX-MBESCBES-CATEGORY-OF-SERVICE (CIP270, CLT224, COT211, CRX150)	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION XIX-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|48\|ARP Section 9813 Qualified Community Based Mobile Crisis Intervention – 85%
11/08/2024	3.31.0	TYPE-OF-OTHER-THIRD-PARTY-LIABILITY (TPL067)	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION TYPE-OF-OTHER-THIRD-PARTY-LIABILITY\|00010101\|99991231\|5\|Worker's Compensation	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION TYPE-OF-OTHER-THIRD-PARTY-LIABILITY\|00010101\|99991231\|5\|Workers' Compensation
09/13/2024	3.29.0	ELG.087	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-GROUP\|00010101\|99991231\|59\|Medically Needy Aged, Blind or Disabled\|Individuals who are age 65 or older, blind or disabled, who are not eligible as categorically needy, who meet income and resource standards specified by the State, or who meet the income standard using medical and remedial care expenses to offset excess i	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-GROUP\|00010101\|99991231\|59\|Medically Needy Aged, Blind or Disabled\|Individuals who are age 65 or older, blind or disabled, who are not eligible as categorically needy, who meet income and resource standards specified by the State, or who meet the income standard using medical and remedial care expenses to offset excess income.
09/13/2024	3.29.0	ELG.087	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-GROUP\|00010101\|99991231\|69\|Individuals with mental health conditions who do not qualify for Medicaid due to the severity or duration of their disability or due to other eligibility factors; and/or those who are otherwise eligible but require benefits or services that are not compar	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-GROUP\|00010101\|99991231\|69\| Individuals with mental health conditions who do not qualify for Medicaid due to the severity or duration of their disability or due to other eligibility factors; and/or those who are otherwise eligible but require benefits or services that are not comparable to those provided to other Medicaid beneficiaries.
09/13/2024	3.29.0	ELG.087	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-GROUP\|00010101\|99991231\|70\|Individuals of child bearing age who require family planning services and supplies and for which the state does not choose to, or cannot provide, optional eligibility coverage under the Individuals Eligible for Family Planning Services eligibility group (	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-GROUP\|00010101\|99991231\|70\| Individuals of child bearing age who require family planning services and supplies and for which the state does not choose to, or cannot provide, optional eligibility coverage under the Individuals Eligible for Family Planning Services eligibility group (1902(a)(10)(A)(ii)(XXI)).
06/07/2024	3.26.0	PRV057, ELG072	Update	Data Dictionary - Valid Values	Shannon County, South Dakota and 113 county code	Shannon County, South Dakota, was renamed as Oglala Lakota County and the county code changed from 113 to 102.
04/17/2024	3.24.0	VV End-Dates for WAIVER-TYPE	Update	Data Dictionary - Valid Values	VV End-Dates for WAIVER-TYPE was 12/31/9999 for the following WAIVER-TYPE Valid Values: 02-19 & 21.	VV End-Dates for WAIVER-TYPE has been updated with ‘10/31/2028’ for the following WAIVER-TYPE Valid Values: 02-19 & 21.
03/15/2024	3.21.0	Rule-1378	Update	Data Dictionary - Valid Values	not a valid value within CMS	CLAIM-PYMT-REM-CODE
03/15/2024	3.21.0	REBATE-ELIGIBLE-INDICATOR - 0	Update	Data Dictionary - Valid Values	NDC is not eligible for drug rebate program. (Manufacturer does not have a rebate agreement.)	NDC is not eligible for drug rebate program. (Manufacturer does not have a rebate agreement.) Drug meets the definition of a covered outpatient drug (COD), but manufacturer does not participate in the rebate program.
03/15/2024	3.21.0	REBATE-ELIGIBLE-INDICATOR - 1	Update	Data Dictionary - Valid Values	NDC is eligible for drug rebate program	NDC is eligible for drug rebate program NDC is listed on the MDP
03/15/2024	3.21.0	REBATE-ELIGIBLE-INDICATOR - 2	Update	Data Dictionary - Valid Values	NDC is exempt from the drug rebate program (biological and medical devices)	NDC is exempt from the drug rebate program (biological and medical devices) these are prescribed drugs that do not meet the definition of a COD. There are several examples, the easiest is insect repellant. State release 178 provides more details. https://www.medicaid.gov/medicaid-chip-program-information/by-topics/prescription-drugs/downloads/rx-releases/state-releases/state-rel-178.pdf
03/15/2024	3.21.0	PROV-CLASSIFICATION-CODE-TYPE-1	Update	Data Dictionary - Valid Values	reference files containing provider taxonomy are out of sync	Valid Values updated
03/15/2024	3.21.0	PROV-TAXONOMY	Update	Data Dictionary - Valid Values	reference files containing provider taxonomy are out of sync	Valid Values updated
03/01/2024	3.20.0	ADJUSTMENT-IND and LINE-ADJUSTMENT-IND CIP026	Update	Data Dictionary - Valid Values	Original Claim/Encounter	Original Claim/Encounter/Payment - Indicates that this is the first (and, when applicable, only) fully adjudicated transaction in a claim family (one or more claims with the related ICN-ORIG and/or ICN-ADJ and typically the same MSIS ID and provider ID(s) also).
03/01/2024	3.20.0	ADJUSTMENT-IND and LINE-ADJUSTMENT-IND CIP026	Update	Data Dictionary - Valid Values	Void of a prior submission	Void/Reversal/Cancel of a prior submission Use this code to convey that the purpose of the transaction is to void/reverse/cancel a previously paid/approved claim/encounter/payment where the claim/encounter/payment is not being replaced by a new paid/approved version of the claim/encounter/payment. Typically, this would be the last claim/encounter/payment that would ever be associated with a given claim family. These records must have the same ICN-ORIG or ICN-ADJ as the claim/encounter being voided. CMS expects a void transaction to also have the same MSIS ID and provider ID(s) as the claim/encounter/payment being voided/reversed/cancelled.
03/01/2024	3.20.0	ADJUSTMENT-IND and LINE-ADJUSTMENT-IND CIP026	Update	Data Dictionary - Valid Values	Debit Adjustment (positive supplemental)	Replacement/Resubmission of a previously paid/approved claim/encounter/payment - Use when the purpose of the transaction is to replace a previously paid/approved claim/encounter/payment with a new paid/approved version of the claim/encounter/payment. These records must have the same ICN-ORIG or ICN-ADJ as the claim/encounter being replaced. CMS expects a replacement transaction to also have the same MSIS ID and provider ID(s) as the claim/encounter/payment being replaced/resubmitted.
03/01/2024	3.20.0	ADJUSTMENT-IND and LINE-ADJUSTMENT-IND CIP026	Update	Data Dictionary - Valid Values	Credit Gross Adjustment	Credit Gross Adjustment - Use this code to indicate an aggregate provider-level recoupment of payments (e.g., not attributable to a single beneficiary). Amounts on these claims should be expressed as negative numbers. If a credit gross adjustment is reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or debit) then CMS will interpret this to mean that the credit gross adjustment with the more recent adjudication date should completely replace the preceding related gross adjustment. If the ICNs of a credit gross adjustment are not related to any other gross adjustments (credit or debit) then the credit gross adjustment will always be treated as a distinct financial transaction.
03/01/2024	3.20.0	ADJUSTMENT-IND and LINE-ADJUSTMENT-IND CIP026	Update	Data Dictionary - Valid Values	Debit Gross Adjustment	Debit Gross Adjustment - Use this code to indicate an aggregate provider-level payment to a provider (e.g., not attributable to a single beneficiary). Amounts on these claims should be expressed as positive numbers. If a debit gross adjustment is reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or debit) then CMS will interpret this to mean that the credit gross adjustment with the more recent adjudication date should completely replace the preceding related gross adjustment. If the ICNs of a debit gross adjustment are not related to any other gross adjustments (credit or debit) then the debit gross adjustment will always be treated as a distinct financial transaction.
03/01/2024	3.20.0	LINE-ADJUSTMENT-IND CIP239	Update	Data Dictionary - Valid Values	Original Claim/Encounter	Original Claim/Encounter/Payment - Indicates that this is the first (and, when applicable, only) fully adjudicated transaction in a claim family (one or more claims with the related ICN-ORIG and/or ICN-ADJ and typically the same MSIS ID and provider ID(s) also).
03/01/2024	3.20.0	LINE-ADJUSTMENT-IND CIP239	Update	Data Dictionary - Valid Values	Void of a prior submission	Void/Reversal/Cancel of a prior submission Use this code to convey that the purpose of the transaction is to void/reverse/cancel a previously paid/approved claim/encounter/payment where the claim/encounter/payment is not being replaced by a new paid/approved version of the claim/encounter/payment. Typically, this would be the last claim/encounter/payment that would ever be associated with a given claim family. These records must have the same ICN-ORIG or ICN-ADJ as the claim/encounter being voided. CMS expects a void transaction to also have the same MSIS ID and provider ID(s) as the claim/encounter/payment being voided/reversed/cancelled.
03/01/2024	3.20.0	LINE-ADJUSTMENT-IND CIP239	Update	Data Dictionary - Valid Values	Debit Adjustment (positive supplemental)	Replacement/Resubmission of a previously paid/approved claim/encounter/payment - Use when the purpose of the transaction is to replace a previously paid/approved claim/encounter/payment with a new paid/approved version of the claim/encounter/payment. These records must have the same ICN-ORIG or ICN-ADJ as the claim/encounter being replaced. CMS expects a replacement transaction to also have the same MSIS ID and provider ID(s) as the claim/encounter/payment being replaced/resubmitted.
03/01/2024	3.20.0	LINE-ADJUSTMENT-IND CIP239	Update	Data Dictionary - Valid Values	Credit Gross Adjustment	Credit Gross Adjustment - Use this code to indicate an aggregate provider-level recoupment of payments (e.g., not attributable to a single beneficiary). Amounts on these claims should be expressed as negative numbers. If a credit gross adjustment is reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or debit) then CMS will interpret this to mean that the credit gross adjustment with the more recent adjudication date should completely replace the preceding related gross adjustment. If the ICNs of a credit gross adjustment are not related to any other gross adjustments (credit or debit) then the credit gross adjustment will always be treated as a distinct financial transaction.
03/01/2024	3.20.0	LINE-ADJUSTMENT-IND CIP239	Update	Data Dictionary - Valid Values	Debit Gross Adjustment	Debit Gross Adjustment - Use this code to indicate an aggregate provider-level payment to a provider (e.g., not attributable to a single beneficiary). Amounts on these claims should be expressed as positive numbers. If a debit gross adjustment is reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or debit) then CMS will interpret this to mean that the credit gross adjustment with the more recent adjudication date should completely replace the preceding related gross adjustment. If the ICNs of a debit gross adjustment are not related to any other gross adjustments (credit or debit) then the debit gross adjustment will always be treated as a distinct financial transaction.
02/16/2024	3.19.0	RULE-7985	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', '686' 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: '1', '3', 'A', 'C', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
02/16/2024	3.19.0	RULE-7986	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', '686' 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: '1', '3', 'A', 'C', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
02/16/2024	3.19.0	RULE-7987	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', '686' 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: '4', 'D' then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
02/16/2024	3.19.0	RULE-7988	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', '686' 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: '4', 'D' then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
02/01/2024	3.18.0	N/A	UPDATE	Data Dictionary - Valid Values	HCPCS Code Set PROCEDURE-CODE.psv as of 08/23/2023	HCPCS Code Set Update PROCEDURE-CODE.psv as of 01/26/2024
09/22/2023	3.13.0	RULE-7262	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-LINE-RECORD-IP.CLAIM-LINE-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: '1', 'A', then CLAIM-LINE-RECORD-IP has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT	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-LINE-RECORD-IP.CLAIM-LINE-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: '1', 'A' and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMTand CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT does not equal '0.00',then CLAIM-LINE-RECORD-IP has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT
09/22/2023	3.13.0	RULE-7263	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' 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-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-LT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT	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' 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-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' aand CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT does not equal '0.00', then CLAIM-LINE-RECORD-LT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT
09/22/2023	3.13.0	RULE-7265	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-RX has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT does not equal '0.00', then CLAIM-LINE-RECORD-RX has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT
09/22/2023	3.13.0	RULE-7892	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT does not equal '0.00', then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT
09/22/2023	3.13.0	RULE-7446	UPDATE	Data Dictionary - Validation Rules	#of RX claim lines with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal ''F2'' and with CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal ''0'' and with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal ''Z'' and with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: ''26'', ''026'', ''87'', ''087'', ''542'', ''585'', ''654'' and with CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to ''0'' or ''4'' and with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: ''1'', ''3'', ''A'', ''C'' and with CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: ''26'', ''026'', ''87'', ''087'', ''542'', ''585'', ''654'' and with CLAIM-LINE-RECORD-RX has a non-null value for SERVICING-PROV-NUM'	#of RX claim headerswith CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and with CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'and with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and with CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4'and with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C'and with CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM
09/08/2023	3.12.0	RULE-7736	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMTand CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT does not equal '0.00', then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT
09/08/2023	3.12.0	COT123	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION PLACE-OF-SERVICE\|20231001\|99991231\|27\|Outreach Site/ Street\| A non-permanent location on the street or found environment, not described by any other POS code, where health professionals provide preventive, screening, diagnostic, and/or treatment services to unsheltered homeless individuals.
09/08/2023	3.12.0	N/A	UPDATE	Data Dictionary - Valid Values	Update latest ICD-10-procedure-code Valid Value file	PROCEDURE-CODE.psv
09/08/2023	3.12.0	N/A	UPDATE	Data Dictionary - Valid Values	Update Latest ICD-10-diagnosis-code Valid Values file	DIAGNOSIS-CODE.psv
09/08/2023	3.12.0	CIP004, CLT004, COT004, CRX004, ELG004, MCR004, PRV004, TPL004	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION FILE-ENCODING-SPECIFICATION\|00010101\|99991231\|FIX\|The file follows a fixed length format.	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION \|\|\|\|\|\|
09/08/2023	3.12.0	CIP004, CLT004, COT004, CRX004, ELG004, MCR004, PRV004, TPL004	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION FILE-ENCODING-SPECIFICATION\|00010101\|99991231\|PSV\|The file follows a pipe-delimited format.	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION FILE-ENCODING-SPECIFICATION\|00010101\|99991231\|PSV\|The file follows a pipe-separated value format.
09/08/2023	3.12.0	CIP257, CLT211, COT186, CRX134	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION TYPE-OF-SERVICE\|00010101\|99991231\|005\|Professional laboratory services, Technical laboratory services\|	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION TYPE-OF-SERVICE\|00010101\|99991231\|005\|Professional laboratory services\|
08/11/2023	3.11.0	RULE-7980	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBLE-CONTACT-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM, and ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-ZIP-CODE then the concatenation of ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-STATE and substring(ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ZIP-CODE, 0, 5) must be contained in the set of valid values with id: 'ZIP-CODE' and (if ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE is non-null then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date)
08/11/2023	3.11.0	RULE-7532	UPDATE	Data Dictionary - Validation Rules	if ELIGIBLE-CONTACT-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM, then ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-COUNTY-CODE and the concatenation of ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-STATE and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-COUNTY-CODE must be contained in the set of valid values with id: 'COUNTY' and (if ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE is non-null then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date)and ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-ZIP-CODE and the concatenation of ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-STATE and substring(ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ZIP-CODE, 0, 5) must be contained in the set of valid values with id: 'ZIP-CODE' and (if ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE is non-null then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date)'	f ELIGIBLE-CONTACT-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM, and ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-COUNTY-CODE then the concatenation of ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-STATE and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-COUNTY-CODE must be contained in the set of valid values with id: 'COUNTY' and (if ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE is non-null then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date)
07/14/2023	3.10.0	ELG097	ADD	Data Dictionary	N/A	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT\| ELG097\|RESTRICTED-BENEFITS-CODE\|(Restricted Benefits) if value is "G", then Dual Eligible Code (ELG.005.085) must be in (‘01’, ‘03', ‘06’)\|
07/14/2023	3.10.0	ELG270	ADD	Data Dictionary	N/A	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT\| ELG270\|LOCKED-IN-SRVCS\|Must be a 3 digit value from the Type-of-Service valid value list\|
07/14/2023	3.10.0	ELG040	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT\| ELG040\|CITIZENSHIP-IND\|Value must be in [0, 1] or not populated\|	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT\| ELG040\|CITIZENSHIP-IND\|Value must be in [0, 1, 2] or not populated\|
07/14/2023	3.10.0	CIP202	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\|CODING REQUIREMENT\| CIP202\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount.\|"First five (5) characters of the value must be a Julian date express in the form YYDDD (e.g. 19095, 95th day of 20(19))"	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\|CODING REQUIREMENT\| CIP202\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The RA is the detailed explanation of the reason for the payment amount.\|\|
07/14/2023	3.10.0	CLT144	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\|CODING REQUIREMENT\| CLT144\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detaile dexplanation of the reason for the payment amount.\|"First five (5) characters of the value must be a Julian date express in the form YYDDD (e.g. 19095, 95th day of 20(19))"	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\|CODING REQUIREMENT\| CLT144\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The RA is the detailed explanation of the reason for the payment amount.\|\|
07/14/2023	3.10.0	COT126	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\|CODING REQUIREMENT\| COT126\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount.\|"First five (5) characters of the value must be a Julian date express in the form YYDDD (e.g. 19095, 95th day of 20(19))"	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\|CODING REQUIREMENT\| COT126\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The RA is the detailed explanation of the reason for the payment amount.\|\|
07/14/2023	3.10.0	CRX081	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\|CODING REQUIREMENT\| CRX081\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount.\|"First five (5) characters of the value must be a Julian date express in the form YYDDD (e.g. 19095, 95th day of 20(19))"\|	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\|CODING REQUIREMENT\| CRX081\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The RA is the detailed explanation of the reason for the payment amount.\|\|
07/14/2023	3.10.0	CIP194	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT\| CIP194\|DRG-OUTLIER-AMT\|Value must not be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'\|	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT\| CIP194\|DRG-OUTLIER-AMT\|Value must be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'\|
08/11/2023	3.11.0	RULE-7744	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.TYPE-OF-CLAIM equals '3' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals ‘1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08'
08/11/2023	3.11.0	RULE-7743	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM equals '3' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '04', '08'
08/11/2023	3.11.0	RULE-7741	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM equals '3' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '04', '08'
08/11/2023	3.11.0	RULE-7742	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM equals '3' and CLAIM-HEADER-RECORD- RX.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for PRESCRIPTION-FILL-DATE, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08'
08/11/2023	3.11.0	Rule-7981	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.TYPE-OF-CLAIM equals '1' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals ‘1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08'
08/11/2023	3.11.0	Rule-7982	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM equals '1' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08'
08/11/2023	3.11.0	Rule-7983	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM equals '1' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08'
08/11/2023	3.11.0	Rule-7984	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM equals '1' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for PRESCRIPTION-FILL-DATE, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08'
08/11/2023	3.11.0	Rule-7559	UPDATE	Data Dictionary - Validation Rules	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE, then VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-BENEFICIARY-IDENTIFIER or VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-HIC-NUM'	N/A
08/11/2023	3.11.0	Rule-7194	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.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)	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', '686’ and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)
07/14/2023	3.10.0	Rule-7412	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.TYPE-OF-CLAIM is equal to one of the following: '1', '3' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10'	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.TYPE-OF-CLAIM is equal to one of the following: '1', '3' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals ‘1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08'
07/14/2023	3.10.0	Rule-7413	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10'	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08'
07/14/2023	3.10.0	Rule-7414	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for PRESCRIPTION-FILL-DATE, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for PRESCRIPTION-FILL-DATE, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08'
07/14/2023	3.10.0	Rule-7424	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08'
07/14/2023	3.10.0	Rule-7974	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT.HCBS-SERVICE-CODE is equal to '4' then CLAIM-HEADER-RECORD-OT has a non-null value for WAIVER-ID
07/14/2023	3.10.0	Rule-7975	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT.HCBS-SERVICE-CODE is equal to '4' then CLAIM-HEADER-RECORD-OT has a non-null value for WAIVER-ID
07/14/2023	3.10.0	Rule-7937	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and 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 and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-IP has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
07/14/2023	3.10.0	Rule-7938	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.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 one of the following: '1', 'A' 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 TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT does not equal 0.00 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 has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-LT has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
07/14/2023	3.10.0	Rule-7939	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT does not equal 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-OT has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
07/14/2023	3.10.0	Rule-7940	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT does not equal 0.00 and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-RX has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
07/14/2023	3.10.0	Rule-7945	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP has a non-null value 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 and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
07/14/2023	3.10.0	Rule-7946	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.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 '1' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 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 equals '01', then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
07/14/2023	3.10.0	Rule-7947	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
07/14/2023	3.10.0	Rule-7948	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
07/14/2023	3.10.0	RULE-7949	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP has a non-null value 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 and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
07/14/2023	3.10.0	RULE-7950	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.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 'A' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 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 equals '02', then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
07/14/2023	3.10.0	RULE-7951	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
07/14/2023	3.10.0	RULE-7952	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
07/14/2023	3.10.0	RULE-7953	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and 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 greater than zero and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
07/14/2023	3.10.0	RULE-7954	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.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 '1' 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 TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is greater than zero 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 '02', then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
07/14/2023	3.10.0	RULE-7955	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is greater than zero and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
07/14/2023	3.10.0	RULE-7956	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is greater than zero and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
07/14/2023	3.10.0	RULE-7921	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: '3', 'C' and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
07/14/2023	3.10.0	RULE-7922	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
07/14/2023	3.10.0	RULE-7923	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
07/14/2023	3.10.0	RULE-7924	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
07/14/2023	3.10.0	RULE-7925	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: '3', 'C' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NUM, then there are greater than 0 PROV-MEDICAID-ENROLLMENT records with matching join keys and the CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE are overlapping with the PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE,where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
07/14/2023	3.10.0	RULE-7926	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' 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 has a non-null value for SERVICING-PROV-NUM, then there are greater than 0 PROV-MEDICAID-ENROLLMENT records with matching join keys and the CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE are overlapping with the PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE,where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
07/14/2023	3.10.0	RULE-7927	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NUM, then there are greater than 0 PROV-MEDICAID-ENROLLMENT records with matching join keys and the CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE are overlapping with the PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
07/14/2023	3.10.0	RULE-7928	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys and the PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE are overlapping with the CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
07/14/2023	3.10.0	Rule-7929	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: '1', 'A' and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
07/14/2023	3.10.0	Rule-7930	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
07/14/2023	3.10.0	Rule-7931	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
07/14/2023	3.10.0	Rule-7932	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
07/14/2023	3.10.0	RULE-7933	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: '1', 'A' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NUM, then there are greater than 0 PROV-MEDICAID-ENROLLMENT records with matching join keys and the CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE are overlapping with the PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
07/14/2023	3.10.0	RULE-7934	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' 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 has a non-null value for SERVICING-PROV-NUM, then there are greater than 0 PROV-MEDICAID-ENROLLMENT records with matching join keys and the CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE are overlapping with the PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
07/14/2023	3.10.0	RULE-7935	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NUM, then there are greater than 0 PROV-MEDICAID-ENROLLMENT records with matching join keys and the CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE are overlapping with the PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
07/14/2023	3.10.0	RULE-7936	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys and the PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE are overlapping with the CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
07/14/2023	3.10.0	Rule-7976	ADD	Data Dictionary - Validation Rules	N/A	if all CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR is equal to '0'
07/14/2023	3.10.0	Rule-7977	ADD	Data Dictionary - Validation Rules	N/A	if all CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR is equal to '0'
07/14/2023	3.10.0	Rule-7978	ADD	Data Dictionary - Validation Rules	N/A	if all CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR is equal to '0'
07/14/2023	3.10.0	Rule-7979	ADD	Data Dictionary - Validation Rules	N/A	if all CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR is equal to '0'
07/14/2023	3.10.0	N/A	ADD	Data Dictionary - Valid Values	Update latest HCPCS Valid Value file	https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update
07/14/2023	3.10.0	CIP022	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| CIP022\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| CIP022\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	CIP022	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| CIP022\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| CIP022\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	CIP234	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| CIP234\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| CIP234\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	CIP234	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| CIP234\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| CIP234\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	CLT022	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| CLT022\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| CLT022\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	CLT022	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| CLT022\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| CLT022\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	CLT187	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| CLT187\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| CLT187\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	CLT187	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| CLT187\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| CLT187\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	COT022	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| COT022\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| COT022\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	COT022	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| COT022\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| COT022\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	COT157	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| COT157\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| COT157\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	COT157	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| COT157\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| COT157\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	CRX022	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| CRX022\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| CRX022\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	CRX022	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| CRX022\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| CRX022\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	CRX111	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| CRX111\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| CRX111\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	CRX111	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| CRX111\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| CRX111\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG019	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG019\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG019\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG019	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG019\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG019\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG033	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG033\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG033\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG064	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG064\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG064\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG064	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG064\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG064\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG082	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG082\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG082\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG082	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG082\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG082\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG106	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG016\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG106\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG106	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG016\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG106\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG117	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG117\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG117\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG117	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG117\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG117\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG129	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG129\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG129\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG129	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG129\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG129\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG139	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG139\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG139\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG139	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG139\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG139\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG149	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG149\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG149\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG149	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG149\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG149\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG162	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG162\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG162\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG162	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG162\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG162\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG171	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG171\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG171\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG171	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG171\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG171\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG181	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG181\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG181\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG181	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG181\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG181\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG191	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG191\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG191\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG191	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG191\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG191\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG203	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG203\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG203\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG203	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG203\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG203\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG212	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG212\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG212\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG212	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG212\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG212\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG223	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG223\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG223\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG223	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG223\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG223\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG232	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG232\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG232\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG232	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG232\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG232\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG241	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG241\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG241\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG241	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG241\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG241\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG251	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG251\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG251\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG251	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG251\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG251\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG260	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG260\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG260\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG260	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| ELG260\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| ELG260\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	TPL019	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| TPL019\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| TPL019\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	TPL019	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| TPL019\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| TPL019\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	TPL032	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| TLP032\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| TPL032\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	TPL032	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| TLP032\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| TPL032\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	TPL066	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| TLP066\|MSIS-IDENTIFICATION-NUM\|For SSN States (i.e. SSN Indicator = 1), value must be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| TPL066\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	TPL066	UPDATE	Data Dictionary	DE No\|DE Name\|Coding Requirement\| TLP066\|MSIS-IDENTIFICATION-NUM\|For Non-SSN States (i.e. SSN Indicator = 0), value must not be equal to eligible individual's SSN\|	DE No\|DE Name\|Coding Requirement\| TPL066\|MSIS-IDENTIFICATION-NUM\|\|
07/14/2023	3.10.0	ELG038	UPDATE	Data Dictionary	DE No\|DE Name\|Definition\| ELG038\|INCOME-CODE\|A code indicating the family income level.	DE No\|DE Name\|Definition\| ELG038\|INCOME-CODE\|A code indicating the federal poverty level range in which the family income falls. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.
07/14/2023	3.10.0	ELG269	UPDATE	Data Dictionary	DE No\|DE Name\|Definition\| ELG269\|ELIGIBLE-FEDERAL-POVERTY-LEVEL-PERCENTAGE\|This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed usingmultiple methodologies (MAGI and Non-MAGI), report the one that applies to their primary eligibility group.	DE No\|DE Name\|Definition\| ELG269\|ELIGIBLE-FEDERAL-POVERTY-LEVEL-PERCENTAGE\|This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group. A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.
06/23/2023	3.9.0	RULE-7941	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT does not equal 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-OT has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
06/23/2023	3.9.0	RULE-7942	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 2' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
06/23/2023	3.9.0	RULE-7943	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'B' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
06/23/2023	3.9.0	RULE-7944	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '2' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is greater than zero and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
06/23/2023	3.9.0	RULE-7957	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMTand CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT does not equal 0.00 and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-IP has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
06/23/2023	3.9.0	RULE-7958	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.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 one of the following: '5', 'E' 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 TOT-MEDICAID-PAID-AMTand CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT does not equal 0.00 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 has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-LT has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
06/23/2023	3.9.0	RULE-7959	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMTand CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT does not equal 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-OT has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
06/23/2023	3.9.0	RULE-7960	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMTand CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT does not equal 0.00 and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-RX has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
06/23/2023	3.9.0	RULE-7961	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '5' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMTand CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
06/23/2023	3.9.0	RULE-7962	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.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 '5' 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 TOT-MEDICAID-PAID-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
06/23/2023	3.9.0	RULE-7963	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '5' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
06/23/2023	3.9.0	RULE-7964	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '5' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
06/23/2023	3.9.0	RULE-7965	ADD	Data Dictionary - Validation Rules	N/A	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to 'E' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP has a non-null value 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 and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
06/23/2023	3.9.0	RULE-7966	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.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 'E' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 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 equals '02', then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
06/23/2023	3.9.0	RULE-7967	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'E' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
06/23/2023	3.9.0	RULE-7968	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to 'E' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
06/23/2023	3.9.0	RULE-7969	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '5' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and 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 greater than zero and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
06/23/2023	3.9.0	RULE-7970	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.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 '5' 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 TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is greater than zero 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 '02', then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
06/23/2023	3.9.0	RULE-7971	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '5' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is greater than zero and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
06/23/2023	3.9.0	RULE-7972	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '5' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is greater than zero and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
06/23/2023	3.9.0	PRV120	UPDATE	Data Dictionary	DE NO\|\|DATA ELEMENT NAME COMPUTING\|\|\|DEFINITION PRV120\|AFFILIATED-PROGRAM-ID\|\|\|A data element to identify the Medicaid/CHIP programs, waivers and demonstrations in which the provider participates.If Affiliated Program Type = 2 (Health Plan State-assigned health plan ID), then the value in Affiliated Program ID is the state-assigned plan ID of the health plan in which a provider is enrolled to provide services. If Affiliated Program Type = 3 (Waiver), then the value in Affiliated Program ID is the core Federal Waiver ID in which a provider isallowed to deliver services to eligible beneficiaries. If Affiliated Program Type = 4 (Health Home Entity), then the value in Affiliated Program ID is the name of a health home in which a provider is participating. If Affiliated Program Type = 5 (Other), then the value in Affiliated Program ID is an identifier for something other than a health plan, waiver, or health home entity.	DE NO\|\|DATA ELEMENT NAME COMPUTING\|\|\|DEFINITION PRV120\|AFFILIATED-PROGRAM-ID\|\|\|A data element to identify the Medicaid/CHIP programs, waivers and demonstrations in which the provider participates.
06/02/2023	3.8.0	Rule-7901	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.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE
06/02/2023	3.8.0	Rule-7904	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE
06/02/2023	3.8.0	Rule-7903	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4',then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE
06/02/2023	3.8.0	Rule-7902	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE
06/02/2023	3.8.0	RULE-7913	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' 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)'
06/02/2023	3.8.0	RULE-7914	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3','C', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
06/02/2023	3.8.0	RULE-7915	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
06/02/2023	3.8.0	RULE-7916	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'
06/02/2023	3.8.0	RULE-7918	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' 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)'
06/02/2023	3.8.0	RULE-7919	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
06/02/2023	3.8.0	RULE-7920	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
06/02/2023	3.8.0	RULE-7917	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'
06/02/2023	3.8.0	Rule-7905	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM and TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-IP.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
06/02/2023	3.8.0	Rule-7906	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-LT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
06/02/2023	3.8.0	Rule-7907	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-OT. TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number
06/02/2023	3.8.0	Rule-7908	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM and TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-RX.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number
06/02/2023	3.8.0	Rule-7909	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM and TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-HEADER-RECORD-IP.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
06/02/2023	3.8.0	Rule-7910	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 1', 'A', then CLAIM-HEADER-RECORD-LT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
06/02/2023	3.8.0	Rule-7911	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-OT. TYPE-OF-CLAIM is equal to one of the following: 1', 'A', then CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
06/02/2023	3.8.0	Rule-7912	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM and TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-HEADER-RECORD-RX.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
06/02/2023	3.8.0	PRV119	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION AFFILIATED-PROGRAM-TYPE\|00010101\|99991231\|7\|Fee-For-Service - (This value is used to identify providers that are affiliated directly with the state’s Medicaid or CHIP agency (or their fiscal intermediary) and reimbursed by the Medicaid or CHIP agency on a FFS basis. The value in the AFFILIATED-PROGRAM-ID data element contains the ANSI state code of the state in which the provider is enrolled to provide services including through the state plan and a waiver.)
05/12/2023	3.7.0	RULE-7530	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBLE-CONTACT-INFORMATION has a non-null value for MSIS-IDENTIFICATION- and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-TYPE equals '01', then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-STATE equals ELIGIBLE-CONTACT-INFORMATION.SUBMITTING-STATE and ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-COUNTY-CODE and the concatenation of ELIGIBLE-CONTACT-INFORMATION.SUBMITTING-STATE and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-COUNTY-CODE must be contained in the set of valid values with id: 'COUNTY' and (if ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE is non-null then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date) and ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-ZIP-CODE and the concatenation of ELIGIBLE-CONTACT-INFORMATION.SUBMITTING-STATE and substring(ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ZIP-CODE, 0, 5) must be contained in the set of valid values with id: 'ZIP-CODE' and (if ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE is non-null then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date)
05/12/2023	3.7.0	RULE-7532	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBLE-CONTACT-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM, then ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-COUNTY-CODE and the concatenation of ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-STATE and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-COUNTY-CODE must be contained in the set of valid values with id: 'COUNTY' and (if ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE is non-null then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date) and ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-ZIP-CODE and the concatenation of ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-STATE and substring(ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ZIP-CODE, 0, 5) must be contained in the set of valid values with id: 'ZIP-CODE' and (if ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE is non-null then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date)
05/12/2023	3.7.0	RULE-7897	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 is equal to one of the following: '5', 'E' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys
05/12/2023	3.7.0	RULE-7898	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 is equal to one of the following: '5', 'E' 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.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys
05/12/2023	3.7.0	RULE-7899	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys
05/12/2023	3.7.0	RULE-7900	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys
05/12/2023	3.7.0	RULE-7452	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.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then (CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT does not equal '0.00')	N/A
05/12/2023	3.7.0	RULE-7453	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then (CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT does not equal '0.00')	N/A
05/12/2023	3.7.0	RULE-7454	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then (CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT does not equal '0.00')	N/A
05/12/2023	3.7.0	RULE-7455	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then (CLAIM-LINE-RECORD-RX has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT does not equal '0.00')	N/A
05/12/2023	3.7.0	RULE-7448	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.CROSSOVER-INDICATOR equals '0'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C',then (CLAIM-HEADER-RECORD-IP has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT equals '0.00')and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT equals '0.00')and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')	N/A
05/12/2023	3.7.0	RULE-7449	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then (CLAIM-HEADER-RECORD-LT has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT equals '0.00') and (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') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')	N/A
05/12/2023	3.7.0	RULE-7450	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then (CLAIM-LINE-RECORD-OT has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')	N/A
05/12/2023	3.7.0	RULE-7451	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then (CLAIM-LINE-RECORD-RX has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')	N/A
05/12/2023	3.7.0	RULE-7892	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT
05/12/2023	3.7.0	RULE-7893	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-LINE-RECORD-IP.CLAIM-LINE-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: '1', 'A', then CLAIM-LINE-RECORD-IP has a non-null value for TYPE-OF-SERVICE
05/12/2023	3.7.0	RULE-7894	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' 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-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-LT has a non-null value for TYPE-OF-SERVICE
05/12/2023	3.7.0	RULE-7895	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-OT has a non-null value for TYPE-OF-SERVICE
05/12/2023	3.7.0	RULE-7896	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-RX has a non-null value for TYPE-OF-SERVICE
05/12/2023	3.7.0	N/A	UPDATE	Data Dictionary - Valid Values	Update latest Provider Taxonomy Codes valid value file	https://x12.org/codes
05/12/2023	3.7.0	N/A	UPDATE	Data Dictionary - Valid Values	Update latest ADJUSTMENT-REASON-CODE valid value file	https://x12.org/codes
05/12/2023	3.7.0	N/A	UPDATE	Data Dictionary - Valid Values	Update latest Claim Status Codes valid value file	https://x12.org/codes
05/12/2023	3.7.0	N/A	UPDATE	Data Dictionary - Valid Values	Update latest Claim Status Category Codes valid value file	https://x12.org/codes
05/12/2023	3.7.0	N/A	UPDATE	Data Dictionary - Valid Values	Update latest CPT valid value file	https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies
05/12/2023	3.7.0	N/A	ADD	Data Dictionary - Valid Values	ADD Zip-Code valid value file	https://www.unitedstateszipcodes.org/zip-code-database/
04/21/2023	3.6.0	Rule-7705	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '2, 'B', 'V' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)	N/A
04/21/2023	3.6.0	Rule-7707	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '2, 'B', 'V' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)	N/A
04/21/2023	3.6.0	Rule-7708	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.TYPE-OF-CLAIM is equal to one of the following: '2, 'B', 'V' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)	N/A
04/21/2023	3.6.0	Rule-7701	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', 'V' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)	N/A
04/21/2023	3.6.0	Rule-7703	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', 'V' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)	N/A
04/21/2023	3.6.0	Rule-7704	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.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', 'V' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)	N/A
04/21/2023	3.6.0	Rule-7868	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: ‘1', 'A', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)
04/21/2023	3.6.0	Rule-7869	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: ‘1', 'A', then if the 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)
04/21/2023	3.6.0	Rule-7870	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: ‘1', 'A', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
04/21/2023	3.6.0	Rule-7871	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: ‘1', 'A', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)
04/21/2023	3.6.0	Rule-7872	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' 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)
04/21/2023	3.6.0	Rule-7873	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
04/21/2023	3.6.0	Rule-7874	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
04/21/2023	3.6.0	Rule-7875	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then if the LINE-ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)
04/21/2023	3.6.0	Rule-7876	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)
04/21/2023	3.6.0	Rule-7877	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then if the 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)
04/21/2023	3.6.0	Rule-7878	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
04/21/2023	3.6.0	Rule-7879	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E',then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)
04/21/2023	3.6.0	Rule-7880	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' 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)
04/21/2023	3.6.0	Rule-7881	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
04/21/2023	3.6.0	Rule-7882	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
04/21/2023	3.6.0	Rule-7883	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then if the LINE-ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)
04/21/2023	3.6.0	Rule-7884	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)
04/21/2023	3.6.0	Rule-7885	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then if the 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)
04/21/2023	3.6.0	Rule-7886	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
04/21/2023	3.6.0	Rule-7887	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D',then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)
04/21/2023	3.6.0	Rule-7888	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' 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)
04/21/2023	3.6.0	Rule-7889	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
04/21/2023	3.6.0	Rule-7890	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)
04/21/2023	3.6.0	Rule-7891	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then if the LINE-ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)
04/21/2023	3.6.0	N/A	ADD	Data Dictionary - Valid Values	Update the latest CPT file	https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies
03/31/2023	3.5.0	Rule-7852	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7853	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7854	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7855	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7856	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then CLAIM-LINE-RECORD-IP.LINE-ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7857	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then CLAIM-LINE-RECORD-LT.LINE-ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7858	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then CLAIM-LINE-RECORD-OT.LINE-ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7859	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7864	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-LINE-RECORD-IP.LINE-ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7865	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-LINE-RECORD-LT.LINE-ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7866	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-LINE-RECORD-OT.LINE-ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7867	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7848	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-LINE-RECORD-IP.LINE-ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7849	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-LINE-RECORD-LT.LINE-ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7850	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-LINE-RECORD-OT.LINE-ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7851	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	RULE-7844	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	RULE-7845	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	RULE-7846	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	RULE-7847	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7860	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7861	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7862	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7863	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND must have a non-null value
03/31/2023	3.5.0	Rule-7836	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.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then (CLAIM-HEADER-RECORD-IP has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')
03/31/2023	3.5.0	Rule-7837	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then (CLAIM-HEADER-RECORD-LT has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT equals '0.00') and (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') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'
03/31/2023	3.5.0	Rule-7838	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then (CLAIM-LINE-RECORD-OT has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'
03/31/2023	3.5.0	Rule-7839	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then (CLAIM-LINE-RECORD-RX has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'
03/31/2023	3.5.0	Rule-7840	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.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then (CLAIM-HEADER-RECORD-IP has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')
03/31/2023	3.5.0	Rule-7841	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then (CLAIM-HEADER-RECORD-LT has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT equals '0.00') and (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') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'
03/31/2023	3.5.0	Rule-7842	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then (CLAIM-LINE-RECORD-OT has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'
03/31/2023	3.5.0	Rule-7843	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then (CLAIM-LINE-RECORD-RX has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'
03/31/2023	3.5.0	ELG095	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|03\|Income reduced - (typically not a reason for termination)\|	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|03\|Income reduced - (do not use - typically not a reason for termination)\|
03/31/2023	3.5.0	ELG095	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|05\|No longer in the foster care system - (do not use - typically not a reason for termination)\|
03/31/2023	3.5.0	N/A	UPDATE	Data Dictionary - Valid Values	Update Quarterly HCPCS valid values	HCPCS Quarterly Update \| CMS
03/10/2023	3.4.0	Rule-2696	UPDATE	Data Dictionary - Validation Rules	N/A	record MANAGED-CARE-ACCREDITATION-ORGANIZATION has corresponding parent record MANAGED-CARE-MAIN
03/10/2023	3.4.0	Rule-2593	UPDATE	Data Dictionary - Validation Rules	N/A	record MANAGED-CARE-LOCATION-AND-CONTACT-INFO has corresponding parent record MANAGED-CARE-MAIN
03/10/2023	3.4.0	Rule-2675	UPDATE	Data Dictionary - Validation Rules	N/A	record MANAGED-CARE-PLAN-POPULATION-ENROLLED has corresponding parent record MANAGED-CARE-MAIN
03/10/2023	3.4.0	Rule-2630	UPDATE	Data Dictionary - Validation Rules	N/A	record MANAGED-CARE-SERVICE-AREA has corresponding parent record MANAGED-CARE-MAIN
03/10/2023	3.4.0	RULE-2969	UPDATE	Data Dictionary - Validation Rules	N/A	record PROV-AFFILIATED-GROUPS has corresponding parent record PROV-ATTRIBUTES-MAIN
03/10/2023	3.4.0	RULE-2988	UPDATE	Data Dictionary - Validation Rules	N/A	record PROV-AFFILIATED-PROGRAMS has corresponding parent record PROV-ATTRIBUTES-MAIN
03/10/2023	3.4.0	RULE-3010	UPDATE	Data Dictionary - Validation Rules	N/A	record PROV-BED-TYPE-INFO has corresponding parent record PROV-LOCATION-AND-CONTACT-INFO
03/10/2023	3.4.0	RULE-2898	UPDATE	Data Dictionary - Validation Rules	N/A	record PROV-IDENTIFIERS has corresponding parent record PROV-LOCATION-AND-CONTACT-INFO
03/10/2023	3.4.0	RULE-2873	UPDATE	Data Dictionary - Validation Rules	N/A	record PROV-LICENSING-INFO has corresponding parent record PROV-LOCATION-AND-CONTACT-INFO
03/10/2023	3.4.0	RULE-2834	UPDATE	Data Dictionary - Validation Rules	N/A	record PROV-LOCATION-AND-CONTACT-INFO has corresponding parent record PROV-ATTRIBUTES-MAIN
03/10/2023	3.4.0	RULE-2946	UPDATE	Data Dictionary - Validation Rules	N/A	record PROV-MEDICAID-ENROLLMENT has corresponding parent record PROV-ATTRIBUTES-MAIN
03/10/2023	3.4.0	RULE-2926	UPDATE	Data Dictionary - Validation Rules	N/A	record PROV-TAXONOMY-CLASSIFICATION has corresponding parent record PROV-ATTRIBUTES-MAIN
03/10/2023	3.4.0	RULE-3143	UPDATE	Data Dictionary - Validation Rules	N/A	record TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION has corresponding parent record TPL-MEDICAID-ELIGIBLE-PERSON-MAIN
03/10/2023	3.4.0	RULE-3120	UPDATE	Data Dictionary - Validation Rules	N/A	record TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES has corresponding parent record TPL-ENTITY-CONTACT-INFORMATION
03/10/2023	3.4.0	RULE-3085	UPDATE	Data Dictionary - Validation Rules	N/A	record TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has corresponding parent record TPL-MEDICAID-ELIGIBLE-PERSON-MAIN
03/10/2023	3.4.0	ELG034	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MARITAL-STATUS\|00010101\|99991231\|15\|Legally Married (to opposite sex)\| MARITAL-STATUS\|00010101\|99991231\|16\|Legally Married (to same sex)\| MARITAL-STATUS\|00010101\|99991231\|17\|Legally Married, spouse present\| MARITAL-STATUS\|00010101\|99991231\|18\|Legally Married, spouse absent\| MARITAL-STATUS\|00010101\|99991231\|19\|Legally Married\| MARITAL-STATUS\|00010101\|99991231\|20\|Partnered or in Civil Union (to opposite sex)\| MARITAL-STATUS\|00010101\|99991231\|21\|Partnered (Registered Domestic Partner) or in Civil Union (to same sex)\| MARITAL-STATUS\|00010101\|99991231\|22\|Partnered (Registered Domestic Partner) or in Civil Union, spouse present\| MARITAL-STATUS\|00010101\|99991231\|23\|Partnered (Registered Domestic Partner) or in Civil Union, spouse absent\| MARITAL-STATUS\|00010101\|99991231\|24\|Partnered (Registered Domestic Partner) or in Civil Union\| MARITAL-STATUS\|00010101\|99991231\|25\|Partnered (Registered Domestic Partner)\| MARITAL-STATUS\|00010101\|99991231\|26\|Civil Union\| MARITAL-STATUS\|00010101\|99991231\|27\|Legally Married, Partnered, or in Civil Union\| MARITAL-STATUS\|00010101\|99991231\|28\|Legally separated (and still legally married)\| MARITAL-STATUS\|00010101\|99991231\|29\|Legally separated\| MARITAL-STATUS\|00010101\|99991231\|30\|Annulled (and not currently married or partnered)\| MARITAL-STATUS\|00010101\|99991231\|31\|Separated (and currently married or partnered)\| MARITAL-STATUS\|00010101\|99991231\|32\|Separated\| MARITAL-STATUS\|00010101\|99991231\|33\|Single, widowed, or divorced\|
03/10/2023	3.4.0	ELG095	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|01\|Excess income\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|02\|Excess assets\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|03\|Income reduced\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|05\|No longer in the foster care system\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|15\|Moved to a different state\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|17\|Lack of verifications\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|19\|Suspension due to incarceration\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|20\|Residence in an Institution for Mental Disease (IMD)\|	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|01\|Income Requirement not met - do not use for changes in household composition\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|02\|Asset requirement not met - do not use for changes in household composition\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|03\|Income reduced - (typically not a reason for termination)\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|05\|N/A\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|15\|Residency requirement not met (e.g., individual moved to a different state, individual has entered or been discharged from an otherwise unspecified facility or institution)\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|17\|Lack of verifications (e.g., unable to successfully verify citizenship status, immigration status, income, or other information from an application; if unverifiable due to non-response, document as "Failure to respond)\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|19\|Suspension/termination due to incarceration - use when the state is able to distinguish a more granular reason than just residency requirement not met\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|20\|Disqualification for residence in an Institution for Mental Disease (IMD) - use when the state is able to distinguish a more granular reason than just residency requirement not met\|
03/10/2023	3.4.0	ELG095	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|23\|Terminated due to Incorrect Granting of Eligibility (e.g., someone is given eligibility in error and then eligibility has to be retracted/terminated)\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|24\|Household or family composition criteria not met (e.g., someone was incorrectly included or excluded from the household or family composition) - do not use for changes in income\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|25\|Non-financial program requirements not met (e.g. child support not paid, failure of drug tests, failure to apply for SSN, etc.)\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|26\|No longer meets categorical eligibility requirements.\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|27\|End of pregnancy/postpartum coverage period - should only be used if the beneficiary did not obtain coverage through another coverage group like parent/caretaker relative\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|28\|Time limited eligibility expired (e.g., Transitional Medical Assistance (TMA)\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|29\|Closed as duplicate\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|30\|Medical/health status or condition or level of care requirements no longer met - for reasons other than no longer being institutionalized or no longer meeting disability requirements (e.g., completed breast and/or cervical cancer treatment, incarcerated individual no longer requires temporary inpatient level of care)\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|31\|Change in federal or state law or policy (e.g., a state or federal program is completely discontinued and not replaced by an equivalent or transitional program; unwinding of the Families First Coronavirus Response Act coverage of COVID testing for otherwise uninsured individuals who would have otherwise continued to be eligible if they had been re-determined eligible for at least the same program had the program not been terminated)\|
03/10/2023	3.4.0	ELG034	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| ELG034\|MARITAL-STATUS\|A code to classify eligible individual's marital/domestic-relationship status. An eligible individual who is younger than 12 years should have a marital status of never married orunknown. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization).\|	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| ELG034\|MARITAL-STATUS\|A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization). Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the state’s marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value.\|
03/10/2023	3.4.0	ELG095	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| ELG095\|ELIGIBILITY-CHANGE-REASON\|The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another.\|	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| ELG095\|ELIGIBILITY-CHANGE-REASON\|The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another. Do not populate if at the time someone loses Medicaid eligibility they become eligible for and enrolled in CHIP. Also do not populate if at the time someone loses CHIP eligibility they become eligible for and enrolled in Medicaid.\|
03/10/2023	3.4.0	ELG074	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| ELG074\|TYPE-OF-LIVING-ARRANGEMENT\|A free-form text field to describe the type of living arrangement used for the eligibility determination process. The field will remain a free-form text data element until MACPro develops a list of valid values. When it becomes available, T-MSIS will align with MACPro valid value lists.\|	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| ELG074\|TYPE-OF-LIVING-ARRANGEMENT\|A free-form text field to describe the type of living arrangement used for the eligibility determination process.\|
02/17/2023	3.3.0	Rule-2120	UPDATE	Data Dictionary - Validation Rules	N/A	record ELIGIBILITY-DETERMINANTS has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	RULE-2473	UPDATE	Data Dictionary - Validation Rules	N/A	record 1115A-DEMONSTRATION-INFORMATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	RULE-2453	UPDATE	Data Dictionary - Validation Rules	N/A	record DISABILITY-INFORMATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	RULE-2086	UPDATE	Data Dictionary - Validation Rules	N/A	record ELIGIBLE-CONTACT-INFORMATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	RULE-2513	UPDATE	Data Dictionary - Validation Rules	N/A	record ENROLLMENT-TIME-SPAN-SEGMENT has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	RULE-2408	UPDATE	Data Dictionary - Validation Rules	N/A	record ETHNICITY-INFORMATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	RULE-2494	UPDATE	Data Dictionary - Validation Rules	N/A	record HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	RULE-2234	UPDATE	Data Dictionary - Validation Rules	N/A	record HEALTH-HOME-CHRONIC-CONDITIONS has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	RULE-2180	UPDATE	Data Dictionary - Validation Rules	N/A	record HEALTH-HOME-SPA-PARTICIPATION-INFORMATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	RULE-2207	UPDATE	Data Dictionary - Validation Rules	N/A	record HEALTH-HOME-SPA-PROVIDERS has corresponding parent record HEALTH-HOME-SPA-PARTICIPATION-INFORMATION
02/17/2023	3.3.0	RULE-2256	UPDATE	Data Dictionary - Validation Rules	N/A	record LOCK-IN-INFORMATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	RULE-2354	UPDATE	Data Dictionary - Validation Rules	N/A	record LTSS-PARTICIPATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	RULE-2377	UPDATE	Data Dictionary - Validation Rules	N/A	record MANAGED-CARE-PARTICIPATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	RULE-2279	UPDATE	Data Dictionary - Validation Rules	N/A	record MFP-INFORMATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	RULE-2430	UPDATE	Data Dictionary - Validation Rules	N/A	record RACE-INFORMATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	RULE-2306	UPDATE	Data Dictionary - Validation Rules	N/A	record STATE-PLAN-OPTION-PARTICIPATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	RULE-3060	UPDATE	Data Dictionary - Validation Rules	N/A	record TPL-MEDICAID-ELIGIBLE-PERSON-MAIN has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	RULE-2039	UPDATE	Data Dictionary - Validation Rules	N/A	record VARIABLE-DEMOGRAPHICS-ELIGIBILITY has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	RULE-2329	UPDATE	Data Dictionary - Validation Rules	N/A	record WAIVER-PARTICIPATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
02/17/2023	3.3.0	N/A	UPDATE	Data Dictionary - Valid Values	Update the latest OCCURRENCE-CODE	Code Sets from CMS UB_04_Data_Files___ALL_CODES_as_of_07_01_2022_FIN__3_.xlsx
08/21/2020	2.4.0	RULE-1016	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for CLAIM-LINE-COUNT, then CLAIM-HEADER-RECORD-LT.CLAIM-LINE-COUNT is equal to the total number of CLAIM-LINE-RECORD-LT records'
08/21/2020	2.4.0	RULE-1151	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE equals '046', then CLAIM-HEADER-RECORD-LT has a valid, non-null value for ICF-IID-DAYS'
08/21/2020	2.4.0	RULE-1203	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X' and CLAIM-LINE-RECORD-LT has a valid, non-null value for MSIS-IDENTIFICATION-NUM, then CLAIM-LINE-RECORD-LT.MSIS-IDENTIFICATION-NUM starts with the '&' symbol'
08/21/2020	2.4.0	RULE-1204	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-LT has corresponding parent record CLAIM-HEADER-RECORD-LT
08/21/2020	2.4.0	RULE-1212	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for LINE-NUM-ADJ and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT has a valid, non-null value for LINE-ADJUSTMENT-IND'
08/21/2020	2.4.0	RULE-1213	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1215	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1216	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid date of the form CCYYMMDD
08/21/2020	2.4.0	RULE-1218	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-LT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE'
08/21/2020	2.4.0	RULE-1219	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-LT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and FILE-HEADER-RECORD-LT has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE is less than or equal to FILE-HEADER-RECORD-LT.END-OF-TIME-PERIOD'
08/21/2020	2.4.0	RULE-1220	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-LT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-LT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE'
08/21/2020	2.4.0	RULE-1222	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid date of the form CCYYMMDD
08/21/2020	2.4.0	RULE-1225	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-LT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-LT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE'
08/21/2020	2.4.0	RULE-1227	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-LT has a valid, non-null value for ENDING-DATE-OF-SERVICE and FILE-HEADER-RECORD-LT has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is less than or equal to FILE-HEADER-RECORD-LT.END-OF-TIME-PERIOD'
08/21/2020	2.4.0	RULE-1228	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1229	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1230	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(6)V999
08/21/2020	2.4.0	RULE-1231	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(6)V999
08/21/2020	2.4.0	RULE-1232	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1233	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT is greater than or equal to the sum of all CLAIM-LINE-RECORD-LT.REVENUE-CHARGE values'
08/21/2020	2.4.0	RULE-1234	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT has a valid, non-null value for REVENUE-CODE, then CLAIM-LINE-RECORD-LT has a valid, non-null value for REVENUE-CHARGE'
08/21/2020	2.4.0	RULE-1236	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1237	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1238	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1239	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1240	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1241	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'C', '3', 'W', then CLAIM-LINE-RECORD-LT has a valid, non-null value for MEDICAID-FFS-EQUIVALENT-AMT'
08/21/2020	2.4.0	RULE-1242	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BILLING-UNIT' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1243	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1244	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '009', '044', '045', '046', '047', '048', '050', '059', '133', '136', '137''
08/21/2020	2.4.0	RULE-1246	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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 is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' 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 has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-LT, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-
08/21/2020	2.4.0	RULE-1247	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(10)
08/21/2020	2.4.0	RULE-1248	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for SERVICING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-LT.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
08/21/2020	2.4.0	RULE-1249	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-LINE-RECORD-LT has a valid, non-null value for SERVICING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2'
08/21/2020	2.4.0	RULE-1250	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1251	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1252	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1253	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1254	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1255	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1258	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-FACILITY-TYPE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1259	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1261	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1262	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for STATE-NOTATION, then CLAIM-LINE-RECORD-LT.STATE-NOTATION does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-1264	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for NATIONAL-DRUG-CODE, then CLAIM-LINE-RECORD-LT.NATIONAL-DRUG-CODE is a valid National Drug Code (NDC) value'
08/21/2020	2.4.0	RULE-1267	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1269	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for HCPCS-RATE, then CLAIM-LINE-RECORD-LT.HCPCS-RATE does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-1272	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-LT has a valid, non-null value for ADJUDICATION-DATE and FILE-HEADER-RECORD-LT has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE is less than or equal to FILE-HEADER-RECORD-LT.END-OF-TIME-PERIOD'
08/21/2020	2.4.0	RULE-1273	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is not equal to one of the following: '2', 'B', 'V' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for ADMISSION-DATE and CLAIM-LINE-RECORD-LT has a valid, non-null value for ADJUDICATION-DATE, then CLAIM-HEADER-RECORD-LT.ADMISSION-DATE is less than or equal to CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE'
08/21/2020	2.4.0	RULE-1274	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1275	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for PRE-AUTHORIZATION-NUM, then CLAIM-LINE-RECORD-LT.PRE-AUTHORIZATION-NUM does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-1391	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT is equal to the sum of all CLAIM-LINE-RECORD-OT.BILLED-AMT values'
08/21/2020	2.4.0	RULE-1393	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-ALLOWED-AMT, then CLAIM-HEADER-RECORD-OT.TOT-ALLOWED-AMT is equal to the sum of all CLAIM-LINE-RECORD-OT.ALLOWED-AMT values'
08/21/2020	2.4.0	RULE-1423	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-OT.BILLING-PROV-NUM'
08/21/2020	2.4.0	RULE-1430	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for CLAIM-LINE-COUNT, then CLAIM-HEADER-RECORD-OT.CLAIM-LINE-COUNT is equal to the total number of CLAIM-LINE-RECORD-OT records'
08/21/2020	2.4.0	RULE-1543	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '121', '122', then CLAIM-HEADER-RECORD-OT has a null or invalid value for BILLING-PROV-NPI-NUM'
08/21/2020	2.4.0	RULE-1546	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '121', '122', then CLAIM-HEADER-RECORD-OT has a null or invalid value for BILLING-PROV-TAXONOMY'
08/21/2020	2.4.0	RULE-1552	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE equals '121', then CLAIM-HEADER-RECORD-OT has a null or invalid value for REFERRING-PROV-NPI-NUM'
08/21/2020	2.4.0	RULE-1554	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '121', '122', then CLAIM-HEADER-RECORD-OT has a null or invalid value for REFERRING-PROV-TAXONOMY'
08/21/2020	2.4.0	RULE-1560	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '121', '122', then CLAIM-HEADER-RECORD-OT has a null or invalid value for PLACE-OF-SERVICE'
08/21/2020	2.4.0	RULE-1590	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE equals '121', then CLAIM-HEADER-RECORD-OT has a null or invalid value for HEALTH-HOME-PROVIDER-NPI'
08/21/2020	2.4.0	RULE-1598	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE equals '121', then CLAIM-HEADER-RECORD-OT has a null or invalid value for UNDER-SUPERVISION-OF-PROV-NPI'
08/21/2020	2.4.0	RULE-1609	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X' and CLAIM-LINE-RECORD-OT has a valid, non-null value for MSIS-IDENTIFICATION-NUM, then CLAIM-LINE-RECORD-OT.MSIS-IDENTIFICATION-NUM starts with the '&' symbol'
08/21/2020	2.4.0	RULE-1610	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-OT has corresponding parent record CLAIM-HEADER-RECORD-OT
08/21/2020	2.4.0	RULE-1615	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.LINE-ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT has a null or invalid value for LINE-NUM-ADJ'
08/21/2020	2.4.0	RULE-1617	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for LINE-NUM-ADJ and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT has a valid, non-null value for LINE-ADJUSTMENT-IND'
08/21/2020	2.4.0	RULE-1618	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1620	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1621	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid date of the form CCYYMMDD
08/21/2020	2.4.0	RULE-1623	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE'
08/21/2020	2.4.0	RULE-1624	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE'
08/21/2020	2.4.0	RULE-1626	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and FILE-HEADER-RECORD-OT has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to FILE-HEADER-RECORD-OT.END-OF-TIME-PERIOD'
08/21/2020	2.4.0	RULE-1627	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid date of the form CCYYMMDD
08/21/2020	2.4.0	RULE-1630	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE'
08/21/2020	2.4.0	RULE-1632	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and FILE-HEADER-RECORD-OT has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to FILE-HEADER-RECORD-OT.END-OF-TIME-PERIOD'
08/21/2020	2.4.0	RULE-1633	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1634	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for PROCEDURE-CODE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.PROCEDURE-CODE is a valid value specified by CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG or is a state valid value from 'PROCEDURE-CODE-STATE'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '01', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'CPT'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '02', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'ICD-9-PROCEDURE-CODE'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '06', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'HCPCS'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '07', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'ICD-10-PROCEDURE-CODE'.'
08/21/2020	2.4.0	RULE-1635	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid date of the form CCYYMMDD
08/21/2020	2.4.0	RULE-1637	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for PROCEDURE-CODE-DATE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-DATE is less than or equal to CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE'
08/21/2020	2.4.0	RULE-1638	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for PROCEDURE-CODE-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-DATE'
08/21/2020	2.4.0	RULE-1641	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1642	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1644	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1645	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1646	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1648	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1649	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1651	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'C', '3', 'W', then CLAIM-LINE-RECORD-OT has a valid, non-null value for MEDICAID-FFS-EQUIVALENT-AMT'
08/21/2020	2.4.0	RULE-1652	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1653	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999
08/21/2020	2.4.0	RULE-1655	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1656	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '127', '131', '134', '135', '136', '137', '138', '139', '140', '141', '142', '143', '144''
08/21/2020	2.4.0	RULE-1658	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TOOTH-QUAD-CODE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '013', '029', '035''
08/21/2020	2.4.0	RULE-1659	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TOOTH-SURFACE-CODE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '013', '029', '015', '028''
08/21/2020	2.4.0	RULE-1660	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-TAXONOMY' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1662	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '121', '122' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT has a null or invalid value for SERVICING-PROV-NUM'
08/21/2020	2.4.0	RULE-1663	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-OT, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-
08/21/2020	2.4.0	RULE-1664	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(10)
08/21/2020	2.4.0	RULE-1665	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-OT.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
08/21/2020	2.4.0	RULE-1666	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '121', '122' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT has a null or invalid value for SERVICING-PROV-NPI-NUM'
08/21/2020	2.4.0	RULE-1667	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE equals '121' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT has a null or invalid value for SERVICING-PROV-NPI-NUM'
08/21/2020	2.4.0	RULE-1668	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2'
08/21/2020	2.4.0	RULE-1669	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1670	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '121', '122' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT has a null or invalid value for SERVICING-PROV-TAXONOMY'
08/21/2020	2.4.0	RULE-1671	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1672	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1673	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1674	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-DESIGNATION-SYSTEM' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1675	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-NUM' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1676	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-QUAD-CODE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1677	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-SURFACE-CODE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1678	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ORIGINATION-ADDR-LN1, then CLAIM-LINE-RECORD-OT.ORIGINATION-ADDR-LN1 does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-1679	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ORIGINATION-ADDR-LN2, then CLAIM-LINE-RECORD-OT.ORIGINATION-ADDR-LN2 does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-1680	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ORIGINATION-CITY, then CLAIM-LINE-RECORD-OT.ORIGINATION-CITY does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-1681	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1682	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ORIGINATION-ZIP-CODE, then CLAIM-LINE-RECORD-OT.ORIGINATION-ZIP-CODE is either a 5-digit or 9-digit number'
08/21/2020	2.4.0	RULE-1683	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for DESTINATION-ADDR-LN1, then CLAIM-LINE-RECORD-OT.DESTINATION-ADDR-LN1 does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-1684	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for DESTINATION-ADDR-LN2, then CLAIM-LINE-RECORD-OT.DESTINATION-ADDR-LN2 does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-1685	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for DESTINATION-ADDR-LN2 and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.DESTINATION-ADDR-LN2 does not equal CLAIM-LINE-RECORD-OT.DESTINATION-ADDR-LN1'
08/21/2020	2.4.0	RULE-1686	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for DESTINATION-CITY, then CLAIM-LINE-RECORD-OT.DESTINATION-CITY does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-1687	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1688	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for DESTINATION-ZIP-CODE, then CLAIM-LINE-RECORD-OT.DESTINATION-ZIP-CODE is either a 5-digit or 9-digit number'
08/21/2020	2.4.0	RULE-1689	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1690	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1693	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1695	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1697	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1698	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for STATE-NOTATION, then CLAIM-LINE-RECORD-OT.STATE-NOTATION does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-1702	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for NATIONAL-DRUG-CODE, then CLAIM-LINE-RECORD-OT.NATIONAL-DRUG-CODE is a valid National Drug Code (NDC) value'
08/21/2020	2.4.0	RULE-1703	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1706	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1709	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for HCPCS-RATE, then CLAIM-LINE-RECORD-OT.HCPCS-RATE does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-1712	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and FILE-HEADER-RECORD-OT has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE is less than or equal to FILE-HEADER-RECORD-OT.END-OF-TIME-PERIOD'
08/21/2020	2.4.0	RULE-1713	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1714	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for PRE-AUTHORIZATION-NUM, then CLAIM-LINE-RECORD-OT.PRE-AUTHORIZATION-NUM does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-1715	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1716	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(6)V999
08/21/2020	2.4.0	RULE-1718	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1789	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT is equal to the sum of all CLAIM-LINE-RECORD-RX.BILLED-AMT values'
08/21/2020	2.4.0	RULE-1791	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-ALLOWED-AMT, then CLAIM-HEADER-RECORD-RX.TOT-ALLOWED-AMT is equal to the sum of all CLAIM-LINE-RECORD-RX.ALLOWED-AMT values'
08/21/2020	2.4.0	RULE-1796	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT, then CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT is equal to the sum of all CLAIM-LINE-RECORD-RX.MEDICARE-DEDUCTIBLE-AMT values', where CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
08/21/2020	2.4.0	RULE-1826	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for CLAIM-LINE-COUNT, then CLAIM-HEADER-RECORD-RX.CLAIM-LINE-COUNT is equal to the total number of CLAIM-LINE-RECORD-RX records'
08/21/2020	2.4.0	RULE-1908	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X' and CLAIM-LINE-RECORD-RX has a valid, non-null value for MSIS-IDENTIFICATION-NUM, then CLAIM-LINE-RECORD-RX.MSIS-IDENTIFICATION-NUM starts with the '&' symbol'
08/21/2020	2.4.0	RULE-1909	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-RX has corresponding parent record CLAIM-HEADER-RECORD-RX
08/21/2020	2.4.0	RULE-1914	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX has a null or invalid value for LINE-NUM-ADJ'
08/21/2020	2.4.0	RULE-1917	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for LINE-NUM-ADJ and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX has a valid, non-null value for LINE-ADJUSTMENT-IND'
08/21/2020	2.4.0	RULE-1920	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1921	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for NATIONAL-DRUG-CODE, then CLAIM-LINE-RECORD-RX.NATIONAL-DRUG-CODE is a valid National Drug Code (NDC) value'
08/21/2020	2.4.0	RULE-1924	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1925	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1926	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(5)V99
08/21/2020	2.4.0	RULE-1927	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1928	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1929	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1930	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'C', '3', 'W', then CLAIM-LINE-RECORD-RX has a valid, non-null value for MEDICAID-FFS-EQUIVALENT-AMT'
08/21/2020	2.4.0	RULE-1931	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1932	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1933	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1934	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999
08/21/2020	2.4.0	RULE-1935	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999
08/21/2020	2.4.0	RULE-1936	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'UNIT-OF-MEASURE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1937	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1938	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '011', '018', '033', '034', '036', '085', '089', '127', '131', '136', '137''
08/21/2020	2.4.0	RULE-1940	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-SERVICE-CODE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1941	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-TAXONOMY' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1942	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1943	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for DAYS-SUPPLY, then CLAIM-LINE-RECORD-RX.DAYS-SUPPLY is greater than or equal to -365 AND less than or equal to 365'
08/21/2020	2.4.0	RULE-1944	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NEW-REFILL-IND' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1945	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BRAND-GENERIC-IND' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1946	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V99
08/21/2020	2.4.0	RULE-1947	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for PRESCRIPTION-NUM, then CLAIM-LINE-RECORD-RX.PRESCRIPTION-NUM does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-1948	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z', then The substring CLAIM-LINE-RECORD-RX.DRUG-UTILIZATION-CODE(0, 2) must be contained in the set of valid values with id: 'DRUG-UTILIZATION-CODE-E4''
08/21/2020	2.4.0	RULE-1949	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(7)V999
08/21/2020	2.4.0	RULE-1950	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'COMPOUND-DOSAGE-FORM' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1951	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REBATE-ELIGIBLE-INDICATOR' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1952	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1953	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1954	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1957	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1959	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1960	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-1961	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for STATE-NOTATION, then CLAIM-LINE-RECORD-RX.STATE-NOTATION does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-1967	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-RX has a valid, non-null value for ADJUDICATION-DATE and FILE-HEADER-RECORD-RX has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.ADJUDICATION-DATE is less than or equal to FILE-HEADER-RECORD-RX.END-OF-TIME-PERIOD'
08/21/2020	2.4.0	RULE-1968	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-1969	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for PRE-AUTHORIZATION-NUM, then CLAIM-LINE-RECORD-RX.PRE-AUTHORIZATION-NUM does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-2758	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DATE-OF-BIRTH and the first character of CLAIM-LINE-RECORD-OT.TOOTH-NUM is one of 'A' through 'T', then the difference between dates CLAIM-HEADER-RECORD-OT.DATE-OF-BIRTH and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is less than 15 years'
08/21/2020	2.4.0	RULE-423	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-1, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-1'
08/21/2020	2.4.0	RULE-436	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-2 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-2'
08/21/2020	2.4.0	RULE-449	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-3 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-3'
08/21/2020	2.4.0	RULE-463	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-4 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-4'
08/21/2020	2.4.0	RULE-476	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-5 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-5'
08/21/2020	2.4.0	RULE-488	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-6 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-6'
08/21/2020	2.4.0	RULE-534	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-ALLOWED-AMT, then CLAIM-HEADER-RECORD-IP.TOT-ALLOWED-AMT is equal to the sum of all CLAIM-LINE-RECORD-IP.ALLOWED-AMT values'
08/21/2020	2.4.0	RULE-577	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for CLAIM-LINE-COUNT, then CLAIM-HEADER-RECORD-IP.CLAIM-LINE-COUNT is equal to the total number of CLAIM-LINE-RECORD-IP records'
08/21/2020	2.4.0	RULE-6074	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.ORIGINATION-ADDR-LN1 does not equal CLAIM-LINE-RECORD-OT.ORIGINATION-ADDR-LN2'
08/21/2020	2.4.0	RULE-6112	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(10)
08/21/2020	2.4.0	RULE-6132	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6133	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6152	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4)
08/21/2020	2.4.0	RULE-6159	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1)
08/21/2020	2.4.0	RULE-6164	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6166	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6173	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6175	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12)
08/21/2020	2.4.0	RULE-6177	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(9)
08/21/2020	2.4.0	RULE-6179	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6183	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999
08/21/2020	2.4.0	RULE-6187	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(5)
08/21/2020	2.4.0	RULE-6192	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(18)
08/21/2020	2.4.0	RULE-6194	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6204	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(30)
08/21/2020	2.4.0	RULE-6216	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(20)
08/21/2020	2.4.0	RULE-6219	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(1)
08/21/2020	2.4.0	RULE-6220	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6238	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(20)
08/21/2020	2.4.0	RULE-6239	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12)
08/21/2020	2.4.0	RULE-6257	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12)
08/21/2020	2.4.0	RULE-6264	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6277	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6316	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6318	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(8)
08/21/2020	2.4.0	RULE-6328	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6334	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6336	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(14)
08/21/2020	2.4.0	RULE-6346	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12)
08/21/2020	2.4.0	RULE-6347	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6349	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(18)
08/21/2020	2.4.0	RULE-6354	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4)
08/21/2020	2.4.0	RULE-6363	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6364	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(30)
08/21/2020	2.4.0	RULE-6371	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(28)
08/21/2020	2.4.0	RULE-6372	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6373	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6375	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6377	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6378	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1)
08/21/2020	2.4.0	RULE-6386	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6387	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6363	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6364	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(30)
08/21/2020	2.4.0	RULE-6371	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(28)
08/21/2020	2.4.0	RULE-6372	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6373	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6375	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6377	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6378	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1)
08/21/2020	2.4.0	RULE-6386	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6387	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6408	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6421	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(500)
08/21/2020	2.4.0	RULE-6425	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6426	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6431	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6435	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6436	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6451	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12)
08/21/2020	2.4.0	RULE-6461	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1)
08/21/2020	2.4.0	RULE-6463	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(5)
08/21/2020	2.4.0	RULE-6482	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6489	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(8)
08/21/2020	2.4.0	RULE-6493	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: 9(11)
08/21/2020	2.4.0	RULE-6495	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1)
08/21/2020	2.4.0	RULE-6496	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6510	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(12)
08/21/2020	2.4.0	RULE-6544	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6565	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6566	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6579	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6589	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6605	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(12)
08/21/2020	2.4.0	RULE-6606	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6609	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(60)
08/21/2020	2.4.0	RULE-6611	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(18)
08/21/2020	2.4.0	RULE-6615	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(60)
08/21/2020	2.4.0	RULE-6623	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1)
08/21/2020	2.4.0	RULE-6628	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(500)
08/21/2020	2.4.0	RULE-6630	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4)
08/21/2020	2.4.0	RULE-6633	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-6638	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(20)
08/21/2020	2.4.0	RULE-6642	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6651	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: 9(11)
08/21/2020	2.4.0	RULE-6654	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6659	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(28)
08/21/2020	2.4.0	RULE-6661	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(6)V999
08/21/2020	2.4.0	RULE-6665	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6689	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6703	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(4)
08/21/2020	2.4.0	RULE-6707	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(12)
08/21/2020	2.4.0	RULE-6716	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6720	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6726	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(9)
08/21/2020	2.4.0	RULE-6730	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6732	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(500)
08/21/2020	2.4.0	RULE-6734	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6740	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6741	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(500)
08/21/2020	2.4.0	RULE-6744	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(8)
08/21/2020	2.4.0	RULE-6784	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6799	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(10)
08/21/2020	2.4.0	RULE-6800	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(18)
08/21/2020	2.4.0	RULE-6804	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6827	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6830	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: 9(11)
08/21/2020	2.4.0	RULE-6853	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(20)
08/21/2020	2.4.0	RULE-6857	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(5)
08/21/2020	2.4.0	RULE-6862	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1)
08/21/2020	2.4.0	RULE-6880	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6898	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(9)
08/21/2020	2.4.0	RULE-6901	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(4)
08/21/2020	2.4.0	RULE-6925	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1)
08/21/2020	2.4.0	RULE-6935	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4)
08/21/2020	2.4.0	RULE-6947	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6952	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-6953	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12)
08/21/2020	2.4.0	RULE-6957	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(60)
08/21/2020	2.4.0	RULE-6958	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(60)
08/21/2020	2.4.0	RULE-6979	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-6983	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-7002	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(14)
08/21/2020	2.4.0	RULE-7012	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-7019	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1)
08/21/2020	2.4.0	RULE-7020	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-7024	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-7027	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4)
08/21/2020	2.4.0	RULE-7031	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: 9(11)
08/21/2020	2.4.0	RULE-7038	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-7047	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-7049	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(6)
08/21/2020	2.4.0	RULE-7059	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12)
08/21/2020	2.4.0	RULE-7060	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12)
08/21/2020	2.4.0	RULE-7062	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12)
08/21/2020	2.4.0	RULE-7065	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
08/21/2020	2.4.0	RULE-7069	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-7077	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(14)
08/21/2020	2.4.0	RULE-7087	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(9)
08/21/2020	2.4.0	RULE-7098	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: X(8)
08/21/2020	2.4.0	RULE-7115	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2)
08/21/2020	2.4.0	RULE-7122	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-7123	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(30)
08/21/2020	2.4.0	RULE-7124	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(8)
08/21/2020	2.4.0	RULE-7134	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-SERVICE-CODE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
08/21/2020	2.4.0	RULE-7202	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z', then The substring CLAIM-LINE-RECORD-RX.DRUG-UTILIZATION-CODE(2, 2) must be contained in the set of valid values with id: 'DRUG-UTILIZATION-CODE-E5''
08/21/2020	2.4.0	RULE-7203	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z', then The substring CLAIM-LINE-RECORD-RX.DRUG-UTILIZATION-CODE(4, 2) must be contained in the set of valid values with id: 'DRUG-UTILIZATION-CODE-E6''
08/21/2020	2.4.0	RULE-7209	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
08/21/2020	2.4.0	RULE-7210	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
08/21/2020	2.4.0	RULE-7217	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
08/21/2020	2.4.0	RULE-7218	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
08/21/2020	2.4.0	RULE-7252	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
08/21/2020	2.4.0	RULE-7253	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
08/21/2020	2.4.0	RULE-7258	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-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: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-IP has a non-null value for TYPE-OF-SERVICE'
08/21/2020	2.4.0	RULE-7259	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-LT has a non-null value for TYPE-OF-SERVICE'
08/21/2020	2.4.0	RULE-7260	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-OT has a non-null value for TYPE-OF-SERVICE'
08/21/2020	2.4.0	RULE-7261	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-RX has a non-null value for TYPE-OF-SERVICE'
08/21/2020	2.4.0	RULE-7262	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-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: '1', 'A', then CLAIM-LINE-RECORD-IP has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'
08/21/2020	2.4.0	RULE-7263	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-LT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'
08/21/2020	2.4.0	RULE-7264	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'
08/21/2020	2.4.0	RULE-7265	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-RX has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'
08/21/2020	2.4.0	RULE-7273	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0' and (CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' or CLAIM-HEADER-RECORD-OT has a null value for CROSSOVER-INDICATOR), then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for MEDICAID-PAID-AMT'
08/21/2020	2.4.0	RULE-7278	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND equals '0', then CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-IP.MEDICAID-PAID-AMT values', where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
08/21/2020	2.4.0	RULE-7279	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND equals '0', then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT values', where CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
08/21/2020	2.4.0	RULE-7280	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0', then CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT values', where CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
08/21/2020	2.4.0	RULE-7281	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0', then CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-RX.MEDICAID-PAID-AMT values', where CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
08/21/2020	2.4.0	RULE-7285	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-OT.PAYMENT-LEVEL-IND equals '2' and CLAIM-LINE-RECORD-OT has a non-null value for MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-OT.ALLOWED-AMT does not equal '0.00' and CLAIM-LINE-RECORD-OT has a non-null value for ALLOWED-AMT, then CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT is less than or equal to CLAIM-LINE-RECORD-OT.ALLOWED-AMT'
08/21/2020	2.4.0	RULE-7293	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE-FLAG, then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE'
08/21/2020	2.4.0	RULE-7294	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE, then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE-FLAG'
08/21/2020	2.4.0	RULE-7295	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '138', '139', '140', '141', '142', '143', '144' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B''
08/21/2020	2.4.0	RULE-7296	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE equals '138', then CLAIM-HEADER-RECORD-OT has a non-null value for HEALTH-HOME-ENTITY-NAME'
08/21/2020	2.4.0	RULE-7300	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.XIX-MBESCBES-CATEGORY-OF-SERVICE equals '45' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686', then CLAIM-HEADER-RECORD-OT has a non-null value for HEALTH-HOME-ENTITY-NAME'
08/21/2020	2.4.0	RULE-7309	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' 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: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NPI-NUM'
08/21/2020	2.4.0	RULE-7310	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NPI-NUM'
08/21/2020	2.4.0	RULE-7311	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NPI-NUM'
08/21/2020	2.4.0	RULE-767	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and CLAIM-LINE-RECORD-IP has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X', then CLAIM-LINE-RECORD-IP.MSIS-IDENTIFICATION-NUM starts with the '&' symbol'
08/21/2020	2.4.0	RULE-768	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-IP has corresponding parent record CLAIM-HEADER-RECORD-IP
08/21/2020	2.4.0	RULE-775	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for LINE-NUM-ADJ and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP has a valid, non-null value for LINE-ADJUSTMENT-IND'
08/21/2020	2.4.0	RULE-776	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE' 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)'
08/21/2020	2.4.0	RULE-778	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' 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)'
08/21/2020	2.4.0	RULE-779	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be a valid date of the form CCYYMMDD
08/21/2020	2.4.0	RULE-781	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and FILE-HEADER-RECORD-IP has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to FILE-HEADER-RECORD-IP.END-OF-TIME-PERIOD'
08/21/2020	2.4.0	RULE-782	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE'
08/21/2020	2.4.0	RULE-783	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-IP has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE'
08/21/2020	2.4.0	RULE-786	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be a valid date of the form CCYYMMDD
08/21/2020	2.4.0	RULE-789	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-IP has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE'
08/21/2020	2.4.0	RULE-791	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE and FILE-HEADER-RECORD-IP has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is less than or equal to FILE-HEADER-RECORD-IP.END-OF-TIME-PERIOD'
08/21/2020	2.4.0	RULE-792	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE' 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)'
08/21/2020	2.4.0	RULE-793	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE' 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)'
08/21/2020	2.4.0	RULE-794	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: S9(6)V999
08/21/2020	2.4.0	RULE-795	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: S9(6)V999
08/21/2020	2.4.0	RULE-796	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-797	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT is greater than or equal to the sum of all CLAIM-LINE-RECORD-IP.REVENUE-CHARGE values'
08/21/2020	2.4.0	RULE-798	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP has a valid, non-null value for REVENUE-CODE, then CLAIM-LINE-RECORD-IP has a valid, non-null value for REVENUE-CHARGE'
08/21/2020	2.4.0	RULE-800	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-801	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-802	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-803	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-804	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: 'C', '3', 'W', then CLAIM-LINE-RECORD-IP has a valid, non-null value for MEDICAID-FFS-EQUIVALENT-AMT'
08/21/2020	2.4.0	RULE-805	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 field is populated, the value must be contained in the set of valid values with id: 'BILLING-UNIT' 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)'
08/21/2020	2.4.0	RULE-806	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 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)'
08/21/2020	2.4.0	RULE-807	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '001', '058', '060', '084', '086', '090', '091', '092', '093', '123', '132', '135', '136', '137''
08/21/2020	2.4.0	RULE-810	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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 is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-IP, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-
08/21/2020	2.4.0	RULE-812	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-IP.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
08/21/2020	2.4.0	RULE-814	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' 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)'
08/21/2020	2.4.0	RULE-815	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' 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)'
08/21/2020	2.4.0	RULE-816	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' 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)'
08/21/2020	2.4.0	RULE-817	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and CLAIM-LINE-RECORD-IP has a valid, non-null value for OPERATING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-IP.OPERATING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
08/21/2020	2.4.0	RULE-819	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP has a valid, non-null value for OPERATING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and 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 there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2'
08/21/2020	2.4.0	RULE-820	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' 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)'
08/21/2020	2.4.0	RULE-821	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 field is populated, the value must be contained in the set of valid values with id: 'PROV-FACILITY-TYPE' 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)'
08/21/2020	2.4.0	RULE-822	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE' 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)'
08/21/2020	2.4.0	RULE-823	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' 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)'
08/21/2020	2.4.0	RULE-826	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-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)'
08/21/2020	2.4.0	RULE-828	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-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)'
08/21/2020	2.4.0	RULE-829	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
08/21/2020	2.4.0	RULE-830	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and CLAIM-LINE-RECORD-IP has a valid, non-null value for STATE-NOTATION, then CLAIM-LINE-RECORD-IP.STATE-NOTATION does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-832	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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 Value must be compatible with specified T-MSIS picture format: S9(6)V999
08/21/2020	2.4.0	RULE-833	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and CLAIM-LINE-RECORD-IP has a valid, non-null value for HCPCS-RATE, then CLAIM-LINE-RECORD-IP.HCPCS-RATE does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-834	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and CLAIM-LINE-RECORD-IP has a valid, non-null value for NATIONAL-DRUG-CODE, then CLAIM-LINE-RECORD-IP.NATIONAL-DRUG-CODE is a valid National Drug Code (NDC) value'
08/21/2020	2.4.0	RULE-837	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE' 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)'
08/21/2020	2.4.0	RULE-840	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-IP has a valid, non-null value for ADJUDICATION-DATE and FILE-HEADER-RECORD-IP has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE is less than or equal to FILE-HEADER-RECORD-IP.END-OF-TIME-PERIOD'
08/21/2020	2.4.0	RULE-841	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: '2', 'B', 'V' and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for ADMISSION-DATE and CLAIM-LINE-RECORD-IP has a valid, non-null value for ADJUDICATION-DATE, then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is less than or equal to CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE'
08/21/2020	2.4.0	RULE-842	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE' 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)'
08/21/2020	2.4.0	RULE-843	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and CLAIM-LINE-RECORD-IP has a valid, non-null value for PRE-AUTHORIZATION-NUM, then CLAIM-LINE-RECORD-IP.PRE-AUTHORIZATION-NUM does not contain any pipe (\|) or asterisk (*) characters'
08/21/2020	2.4.0	RULE-973	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-ALLOWED-AMT, then CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT is equal to the sum of all CLAIM-LINE-RECORD-LT.ALLOWED-AMT values'
08/21/2020	2.4.0	RULE-1964	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE, PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that
08/21/2020	2.4.0	RULE-1939	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE does not equal '086''
08/21/2020	2.4.0	RULE-1955	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02''
08/21/2020	2.4.0	RULE-1958	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-RX.XIX-MBESCBES-CATEGORY-OF-SERVICE is not equal to one of the following: '14', '35', '42', '44''
08/21/2020	2.4.0	RULE-7206	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01''
08/21/2020	2.4.0	RULE-1221	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-LINE-RECORD-LT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'
08/21/2020	2.4.0	RULE-1226	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-LINE-RECORD-LT has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'
08/21/2020	2.4.0	RULE-1256	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02''
08/21/2020	2.4.0	RULE-1260	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-LT.XIX-MBESCBES-CATEGORY-OF-SERVICE is not equal to one of the following: '14', '35', '42', '44''
08/21/2020	2.4.0	RULE-1625	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'
08/21/2020	2.4.0	RULE-1631	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'
08/21/2020	2.4.0	RULE-1639	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-LINE-RECORD-OT has a valid, non-null value for PROCEDURE-CODE-DATE, then CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'
08/21/2020	2.4.0	RULE-1657	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '025', '085''
08/21/2020	2.4.0	RULE-1691	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02''
08/21/2020	2.4.0	RULE-1694	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-OT.XIX-MBESCBES-CATEGORY-OF-SERVICE is not equal to one of the following: '14', '35', '42', '44''
08/21/2020	2.4.0	RULE-519	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '00' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE and 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 CLAIM-HEADER-RECORD-IP.ALLOWED-CHARGE-SRC is not equal to one of the following: '1', 'I', 'K', 'M''
08/21/2020	2.4.0	RULE-7204	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01''
08/21/2020	2.4.0	RULE-7205	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01''
08/21/2020	2.4.0	RULE-7207	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01''
08/21/2020	2.4.0	RULE-784	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'
08/21/2020	2.4.0	RULE-790	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'
08/21/2020	2.4.0	RULE-808	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE does not equal '086''
08/21/2020	2.4.0	RULE-824	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level 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.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02''
08/21/2020	2.4.0	RULE-827	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-IP.XIX-MBESCBES-CATEGORY-OF-SERVICE is not equal to one of the following: '14', '35', '42', '44''
05/24/2019	2.3.0	RULE-978	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT is less than or equal to CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT'	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT is greater than zero and CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT is less than or equal to CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT
05/24/2019	2.3.0	RULE-539	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT is less than or equal to CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT'	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT is greater than zero and CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT is less than or equal to CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT
05/24/2019	2.3.0	RULE-1795	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT is less than or equal to CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT'	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT is greater than zero and CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT is less than or equal to CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT
05/24/2019	2.3.0	RULE-1397	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT is less than or equal to CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT'	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT is greater than zero and CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT is less than or equal to CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT
05/24/2019	2.3.0	RULE-982	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is greater than zero or CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is less than CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT'	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is greater than zero and CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is less than or equal to CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT'
05/24/2019	2.3.0	RULE-543	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT is greater than zero or CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT is less than CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT'	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT is greater than zero and CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT is less than or equal to CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT'
05/24/2019	2.3.0	RULE-1798	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT is less than CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT'	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT is greater than zero and CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT is less than or equal to CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT'
05/24/2019	2.3.0	RULE-1401	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT is less than CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT'	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT is greater than zero and CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT is less than or equal to CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT'
07/19/2019	2.3.0	RULE-1004	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-LT has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM'	N/A
07/19/2019	2.3.0	RULE-1014	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for MEDICAID-COV-INPATIENT-DAYS and CLAIM-HEADER-RECORD-LT has a valid, non-null value for ADMISSION-DATE and CLAIM-HEADER-RECORD-LT has a valid, non-null value for DISCHARGE-DATE, then CLAIM-HEADER-RECORD-LT.MEDICAID-COV-INPATIENT-DAYS is less than or equal to double the number of days between between CLAIM-HEADER-RECORD-LT.ADMISSION-DATE and CLAIM-HEADER-RECORD-LT.DISCHARGE-DATE, plus one day'	N/A
10/02/2020	2.4.0	RULE-1485	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for OCCURRENCE-CODE-01, then CLAIM-HEADER-RECORD-OT has a valid, non-null value for OCCURRENCE-CODE-END-DATE-01'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal ‘F2' and CLAIM-HEADER-RECORD-OT has a non-null value for OCCURRENCE-CODE-01 and CLAIM-HEADER-RECORD-OT.OCCURRENCE-CODE-01 in (’70', ‘71’, ‘72’, ‘73’, ‘74’, ‘75’, ‘76’, ‘77’, ‘78’, ‘79’, ‘80’, ‘81’, ‘99’, 'M0', ‘M1’, ‘M2’, ‘M3’, ‘M4’, ‘ZZ’) then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for OCCURRENCE-CODE-END-DATE-01'
01/31/2020	2.4.0	RULE-1543	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '121', '122', then CLAIM-HEADER-RECORD-OT has a null or invalid value for BILLING-PROV-NPI-NUM'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '121', '122', then CLAIM-HEADER-RECORD-OT has a null or invalid value for BILLING-PROV-NPI-NUM'
07/19/2019	2.3.0	RULE-1819	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM'	N/A
01/31/2020	2.4.0	RULE-2017	UPDATE	Data Dictionary - Validation Rules	if ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64', then the difference between dates PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-BIRTH and FILE-HEADER-RECORD-ELIGIBILITY.START-OF-TIME-PERIOD is less than or equal to 125 years'	if ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-BIRTH and ENROLLMENT-TIME-SPAN-SEGMENT has a valid, non-null value for ENROLLMENT-EFF-DATE, then the difference between dates PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-BIRTH and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE is less than or equal to 125 years'
07/19/2019	2.3.0	RULE-2056	UPDATE	Data Dictionary - Validation Rules	'if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.IMMIGRATION-STATUS is equal to one of the following: '1', '2', '3', then VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for IMMIGRATION-STATUS-FIVE-YEAR-BAR-END-DATE'	N/A
07/19/2019	2.3.0	RULE-544	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-MEDICARE-COINS-AMT'	N/A
07/19/2019	2.3.0	RULE-564	UPDATE	Data Dictionary - Validation Rules	'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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM'	N/A
07/19/2019	2.3.0	RULE-572	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for NON-COV-DAYS and CLAIM-HEADER-RECORD-IP has a valid, non-null value for MEDICAID-COV-INPATIENT-DAYS, then the sum of CLAIM-HEADER-RECORD-IP.NON-COV-DAYS and CLAIM-HEADER-RECORD-IP.MEDICAID-COV-INPATIENT-DAYS is less than or equal to the number of days between the earliest CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE date and the latest CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE date plus one day', where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS does not equal '585'	N/A
07/19/2019	2.3.0	RULE-2021	UPDATE	Data Dictionary - Validation Rules	'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and FILE-HEADER-RECORD-ELIGIBILITY has a valid, non-null value for END-OF-TIME-PERIOD, then PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH is less than or equal to FILE-HEADER-RECORD-ELIGIBILITY.END-OF-TIME-PERIOD'	N/A
07/19/2019	2.3.0	RULE-2195	UPDATE	Data Dictionary - Validation Rules	'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and HEALTH-HOME-SPA-PARTICIPATION-INFORMATION has a valid, non-null value for HEALTH-HOME-SPA-PARTICIPATION-END-DATE, then HEALTH-HOME-SPA-PARTICIPATION-INFORMATION.HEALTH-HOME-SPA-PARTICIPATION-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'	N/A
07/19/2019	2.3.0	RULE-2268	UPDATE	Data Dictionary - Validation Rules	'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and LOCK-IN-INFORMATION has a valid, non-null value for LOCKIN-END-DATE, then LOCK-IN-INFORMATION.LOCKIN-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'	N/A
07/19/2019	2.3.0	RULE-2295	UPDATE	Data Dictionary - Validation Rules	'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and MFP-INFORMATION has a valid, non-null value for MFP-ENROLLMENT-END-DATE, then MFP-INFORMATION.MFP-ENROLLMENT-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'	N/A
07/19/2019	2.3.0	RULE-2318	UPDATE	Data Dictionary - Validation Rules	'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and STATE-PLAN-OPTION-PARTICIPATION has a valid, non-null value for STATE-PLAN-OPTION-END-DATE, then STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'	N/A
07/19/2019	2.3.0	RULE-2343	UPDATE	Data Dictionary - Validation Rules	'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and WAIVER-PARTICIPATION has a valid, non-null value for WAIVER-ENROLLMENT-END-DATE, then WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'	N/A
07/19/2019	2.3.0	RULE-2366	UPDATE	Data Dictionary - Validation Rules	'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and LTSS-PARTICIPATION has a valid, non-null value for LTSS-ELIGIBILITY-END-DATE, then LTSS-PARTICIPATION.LTSS-ELIGIBILITY-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'	N/A
07/19/2019	2.3.0	RULE-2397	UPDATE	Data Dictionary - Validation Rules	'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and MANAGED-CARE-PARTICIPATION has a valid, non-null value for MANAGED-CARE-PLAN-ENROLLMENT-END-DATE, then MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'	N/A
07/19/2019	2.3.0	RULE-2483	UPDATE	Data Dictionary - Validation Rules	'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and 1115A-DEMONSTRATION-INFORMATION has a valid, non-null value for 1115A-END-DATE, then 1115A-DEMONSTRATION-INFORMATION.1115A-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'	N/A
08/16/2019	2.3.0	RULE-1115	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT has a valid, non-null value for DATE-OF-BIRTH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-HEADER-RECORD-LT.DATE-OF-BIRTH is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'	N/A
08/16/2019	2.3.0	RULE-1142	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH is less than or equal to CLAIM-HEADER-RECORD-LT.DISCHARGE-DATE, then CLAIM-HEADER-RECORD-LT.PATIENT-STATUS is equal to one of the following: '20', '40', '41', '42''	N/A
08/16/2019	2.3.0	RULE-1529	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT has a valid, non-null value for DATE-OF-BIRTH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-HEADER-RECORD-OT.DATE-OF-BIRTH is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'	N/A
08/16/2019	2.3.0	RULE-1530	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT has a valid, non-null value for DATE-OF-BIRTH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-BIRTH and ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-HEADER-RECORD-OT.DATE-OF-BIRTH equals PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-BIRTH'	N/A
08/16/2019	2.3.0	RULE-1834	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX has a valid, non-null value for DATE-OF-BIRTH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-HEADER-RECORD-RX.DATE-OF-BIRTH is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'	N/A
08/16/2019	2.3.0	RULE-1835	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX has a valid, non-null value for DATE-OF-BIRTH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-BIRTH and ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-HEADER-RECORD-RX.DATE-OF-BIRTH equals PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-BIRTH'	N/A
08/16/2019	2.3.0	RULE-2308	UPDATE	Data Dictionary - Validation Rules	'if ELIGIBILITY-DETERMINANTS.MAINTENANCE-ASSISTANCE-STATUS equals '0' and ELIGIBILITY-DETERMINANTS.MEDICAID-BASIS-OF-ELIGIBILITY equals '00', then STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-TYPE equals '00''	N/A
08/16/2019	2.3.0	RULE-678	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP has a valid, non-null value for DATE-OF-BIRTH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-BIRTH and ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-HEADER-RECORD-IP.DATE-OF-BIRTH equals PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-BIRTH'	N/A
08/30/2019	2.3.0	RULE-1561	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: S9(5)V9'	N/A
08/16/2019	2.3.0	RULE-7210	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', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', then CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE'
08/16/2019	2.3.0	RULE-7209	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', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', then CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE'
08/16/2019	2.3.0	RULE-7208	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', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', then CLAIM-HEADER-RECORD-IP has a valid, non-null value for ADMISSION-DATE'
08/16/2019	2.3.0	RULE-7213	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.ADJUSTMENT-IND does not equal '1', then CLAIM-HEADER-RECORD-LT has a valid, non-null value for ENDING-DATE-OF-SERVICE'
08/16/2019	2.3.0	RULE-7212	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.ADJUSTMENT-IND does not equal '1', then CLAIM-HEADER-RECORD-LT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE'
08/16/2019	2.3.0	RULE-7214	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1', then CLAIM-HEADER-RECORD-RX has a valid, non-null value for PRESCRIPTION-FILL-DATE'
08/16/2019	2.3.0	RULE-7218	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1', then CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE'
08/16/2019	2.3.0	RULE-7217	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1', then CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE'
08/16/2019	2.3.0	RULE-7216	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1', then CLAIM-HEADER-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE'
08/16/2019	2.3.0	RULE-7215	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1', then CLAIM-HEADER-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE'
08/16/2019	2.3.0	RULE-7211	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', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.PATIENT-STATUS does not equal '30', then CLAIM-HEADER-RECORD-IP has a valid, non-null value for DISCHARGE-DATE'
06/24/2022	3.0.0	ELG270/ LOCKED-IN-SRVCS	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT ELG270\|LOCKED-IN-SRVCS \|X(3)\|ELIGIBLE\|LOCK-IN-INFORMATION-ELG00009
08/21/2020	2.4.0	MANAGED-CARE-PLAN-TYPE (ELG193, MCR024)	UPDATE	Data Dictionary - Valid Values	\|Data Element Name\|Valid Value\|Description\|Effective Date\|End Date\| \|MANAGED-CARE-PLAN-TYPE\|70\|Health/Medical Home\|01/01/0001\|12/31/9999\|	\|Data Element Name\|Valid Value\|Description\|Effective Date\|End Date\| \|MANAGED-CARE-PLAN-TYPE\|70\|Health/Medical Home\|01/01/0001\|09/30/2020\|
06/24/2022	3.0.0	CRX167/ INGREDIENT-COST-SUBMITTED	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX167\|INGREDIENT-COST-SUBMITTED\|S9(11)V99\|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003
06/24/2022	3.0.0	CRX168/ INGREDIENT-COST-PAID-AMT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX168\|INGREDIENT-COST-PAID-AMT\|S9(11)V99\|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003
06/24/2022	3.0.0	CRX169/ DISPENSE-FEE-PAID-AMT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX169\|DISPENSE-FEE-PAID-AMT\|S9(11)V99\|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003
06/24/2022	3.0.0	CRX170/ PROFESSIONAL-SERVICE-FEE-SUBMITTED	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX170\|PROFESSIONAL-SERVICE-FEE-SUBMITTED\|S9(11)V99\|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003
06/24/2022	3.0.0	CRX171/ PROFESSIONAL-SERVICE-FEE-PAID-AMT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX171\|PROFESSIONAL-SERVICE-FEE-PAID-AMT\|S9(11)V99\|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003
11/06/2018	2.3.0	RULE-483	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-6, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-6'	N/A
11/06/2018	2.3.0	RULE-470	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-5, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-5'	N/A
11/06/2018	2.3.0	RULE-456	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-4, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-4'	N/A
11/06/2018	2.3.0	RULE-443	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-3, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-3'	N/A
11/06/2018	2.3.0	RULE-430	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-2, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-2'	N/A
11/06/2018	2.3.0	RULE-417	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-1, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-1'	N/A
11/22/2019	2.3.0	RULE-3060	UPDATE	Data Dictionary - Validation Rules	record TPL-MEDICAID-ELIGIBLE-PERSON-MAIN has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY	N/A
12/13/2019	2.3.0	RULE-7191	UPDATE	Data Dictionary - Validation Rules	IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "1" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be in ("1","2") For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE and VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE <= ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE	IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "1" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be in ("1","2") For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE
12/13/2019	2.3.0	RULE-7192	UPDATE	Data Dictionary - Validation Rules	if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '2', then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE) must be in (ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE, ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE), where VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '3'	IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "2" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be in ("3") For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE
05/08/2020	2.4.0	BEGINNING-DATE-OF-SERVICE (COT033-0003)	UPDATE	Data Dictionary	The beginning date of service must occur before or be the same as the end of time period.	The beginning date of service must occur before or be the same as the end of time period for all claims except capitation payments and service tracking payments.
05/08/2020	2.4.0	BEGINNING-DATE-OF-SERVICE (COT033-0005)	UPDATE	Data Dictionary	Date must occur before or be the same as adjudication date.	Date must occur before or be the same as adjudication date for all claims except capitation payments and service tracking payments.
05/08/2020	2.4.0	ENDING-DATE-OF-SERVICE (COT034-0004)	UPDATE	Data Dictionary	ENDING-DATE-OF-SERVICE must be on or before the ADJUDICATION-DATE.	ENDING-DATE-OF-SERVICE must be on or before the ADJUDICATION-DATE for all claims except capitation payments and service tracking payments
05/08/2020	2.4.0	ENDING-DATE-OF-SERVICE (COT034-0007)	UPDATE	Data Dictionary	Date must occur before or be the same as End of Time Period.	Date must occur before or be the same as End of Time Period for all claims except capitation payments and service tracking payments.
05/08/2020	2.4.0	BEGINNING-DATE-OF-SERVICE (COT166-0004)	UPDATE	Data Dictionary	Date must occur before or be the same as adjudication date.	Date must occur before or be the same as adjudication date for all claims except capitation payments and service tracking payments.
05/08/2020	2.4.0	ENDING-DATE-OF-SERVICE (COT167-0004)	UPDATE	Data Dictionary	ENDING-DATE-OF-SERVICE must be on or before the ADJUDICATION-DATE.	ENDING-DATE-OF-SERVICE must be on or before the ADJUDICATION-DATE for all claims except capitation payments and service tracking payments
05/08/2020	2.4.0	ENDING-DATE-OF-SERVICE (COT167-0007)	UPDATE	Data Dictionary	Date must occur before or be the same as End of Time Period.	Date must occur before or be the same as End of Time Period for all claims except capitation payments and service tracking payments.
06/19/2020	2.4.0	RULE-7300	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-LINE-RECORD-OT.XIX-MBESCBES-CATEGORY-OF-SERVICE is equal to '45' AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' then CLAIM-HEADER-RECORD-OT has a non-null value for 'HEALTH-HOME-ENTITY-NAME'
06/19/2020	2.4.0	XIX-MBESCBES-CATEGORY-OF-SERVICE (COT211)	ADD	Data Dictionary - Valid Values	N/A	\|Data Element Name\|Valid Value\|Description \|Effective Date \|End Date\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE (COT211)\|45\|Health Homes for Substance-Use-Disorder Enrollees per section 1006 of the SUPPORT for Patients and Communities Act\|01/01/0001\|12/31/9999\|
09/11/2020	2.4.0	RULE-7366	ADD	Data Dictionary - Validation Rules	N/A	if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM then PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null and not invalidly formatted value for DATE-OF-BIRTH
09/11/2020	2.4.0	RULE-7367	ADD	Data Dictionary - Validation Rules	N/A	if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM then PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null value for SEX.
09/11/2020	2.4.0	RULE-7368	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBLE-CONTACT-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM then ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-COUNTY-CODE
09/11/2020	2.4.0	RULE-7369	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBLE-CONTACT-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM then ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-ZIP-CODE
03/27/2020	2.4.0	RULE-7243	ADD	Data Dictionary - Validation Rules	N/A	“If PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.RECORD-ID equals ‘ELG00002’, then PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002 has a non-null value for MSIS-IDENTIFICATION-NUM.”
03/27/2020	2.4.0	RULE-7244	ADD	Data Dictionary - Validation Rules	N/A	“If VARIABLE-DEMOGRAPHICS-ELIGIBILITY-ELG00003.RECORD-ID equals ‘ELG00003’, then VARIABLE-DEMOGRAPHICS-ELIGIBILITY-ELG00003 has a non-null value for MSIS-IDENTIFICATION-NUM.”
03/27/2020	2.4.0	RULE-7245	ADD	Data Dictionary - Validation Rules	N/A	“If ELIGIBLE-CONTACT-INFORMATION-ELG00004.RECORD-ID equals ‘ELG00004’, then ELIGIBLE-CONTACT-INFORMATION-ELG00004 has a non-null value for MSIS-IDENTIFICATION-NUM.”
03/27/2020	2.4.0	RULE-7246	ADD	Data Dictionary - Validation Rules	N/A	“If ELIGIBILITY-DETERMINANTS-ELG00005.RECORD-ID equals ‘ELG00005’, then ELIGIBILITY-DETERMINANTS-ELG00005 has a non-null value for MSIS-IDENTIFICATION-NUM.”
03/27/2020	2.4.0	RULE-7247	ADD	Data Dictionary - Validation Rules	N/A	“If ENROLLMENT-TIME-SPAN-ELG00021.RECORD-ID equals ‘ELG00021’, then ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM.”
03/27/2020	2.4.0	RULE-7248	ADD	Data Dictionary - Validation Rules	N/A	“If WAIVER-PARTICIPATION-ELG00012.RECORD-ID equals ‘ELG00012’, then WAIVER-PARTICIPATION-ELG00012 has a non-null value for MSIS-IDENTIFICATION-NUM.”
03/27/2020	2.4.0	RULE-7249	ADD	Data Dictionary - Validation Rules	N/A	“If MANAGED-CARE-PARTICIPATION-ELG00014.RECORD-ID equals ‘ELG00014’, then MANAGED-CARE-PARTICIPATION-ELG00014 has a non-null value for MSIS-IDENTIFICATION-NUM.”
03/27/2020	2.4.0	RULE-7250	ADD	Data Dictionary - Validation Rules	N/A	“If ETHNICITY-INFORMATION-ELG00015.RECORD-ID equals ‘ELG00015’, then PRIMARY-ETHNICITY-INFORMATION-ELG00015 has a non-null value for MSIS-IDENTIFICATION-NUM.”
03/27/2020	2.4.0	RULE-7251	ADD	Data Dictionary - Validation Rules	N/A	“If RACE-INFORMATION-ELG00016.RECORD-ID equals ‘ELG00016’, then RACE-INFORMATION-ELG00016 has a non-null value for MSIS-IDENTIFICATION-NUM.”
05/29/2020	2.4.0	RULE-7266	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 to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM not equal to "Z" AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN ("A", "1") AND CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to "0" AND CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR is equal to "0" or is null then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT'
05/29/2020	2.4.0	RULE-7267	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 not equal to "Z" AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN ("A", "1") AND CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to "0" AND CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR is equal to "1" then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT'
05/29/2020	2.4.0	RULE-7268	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 not equal to "Z" AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN ("A", "1") AND CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0" AND CLAIM-HEADER-LT.CROSSOVER-INDICATOR is equal to "0" or is null then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT'
05/29/2020	2.4.0	RULE-7269	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 not equal to "Z" AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN ("A", "1") AND CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0" AND CLAIM-HEADER-LT.CROSSOVER-INDICATOR is equal to "1" then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT has a non-null and not invalidly formatted value.
05/29/2020	2.4.0	RULE-7270	ADD	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to "Z" AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN ("2", "B") AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT '
05/29/2020	2.4.0	RULE-7271	ADD	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to "Z" AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN ("A", "1") AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" AND CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR is equal to "1" then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT'
05/29/2020	2.4.0	RULE-7272	ADD	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM not equal to "Z" AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN ("A", "1") AND CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0" AND CLAIM-HEADER-RX.CROSSOVER-INDICATOR is equal to "0" or is null then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT'
05/29/2020	2.4.0	RULE-7273	ADD	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to "Z" AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN ("A", "1") AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" AND CLAIM-HEADER-OT.CROSSOVER-INDICATOR is equal to "0" or is null then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for MEDICAID-PAID-AMT'
05/29/2020	2.4.0	RULE-7274	ADD	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to "Z" AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN ("1", "3", "A", "C") AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND IN ("0", "4") then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-BILLED-AMT'
05/29/2020	2.4.0	RULE-7275	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 not equal to "Z" AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN ("1", "3", "A", "C") AND CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND IN ("0", "4") then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-BILLED-AMT '
05/29/2020	2.4.0	RULE-7276	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 not equal to "Z" AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN ("1", "3", "A", "C") AND CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND IN ("0", "4") then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-BILLED-AMT '
05/29/2020	2.4.0	RULE-7277	ADD	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM not equal to "Z" AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN ("1", "3", "A", "C") AND CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND IN ("0", "4") then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-BILLED-AMT '
05/29/2020	2.4.0	RULE-7278	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 not equal to "Z" AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN ("A", "1", "C", "3") AND CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to "0" then Sum of CLAIM-LINE-RECORD-IP.MEDICAID-PAID-AMT is equal to CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT'
05/29/2020	2.4.0	RULE-7279	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 not equal to "Z" AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIMIN ("A", "1", "C", "3") AND CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0" then Sum of CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT is equal to CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT'
05/29/2020	2.4.0	RULE-7280	ADD	Data Dictionary - Validation Rules	N/A	'if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to "Z" AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN ("A", "1", "C", "3") AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" then Sum of CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT is equal to CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT.'
05/29/2020	2.4.0	RULE-7281	ADD	Data Dictionary - Validation Rules	N/A	'if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM not equal to "Z" AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN ("A", "1", "C", "3") AND CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0" then Sum of CLAIM-LINE-RECORD-RX.MEDICAID-PAID-AMT is equal to CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT.'
05/29/2020	2.4.0	RULE-7282	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 not equal to "Z" AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN ("A", "1", "C", "3") AND CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to "0" AND CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is not null AND CLAIM-HEADER-RECORD-IP.TOT-ALLOWED-AMT is not equal to "0" and is not null then CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-IP.TOT-ALLOWED-AMT.
05/29/2020	2.4.0	RULE-7283	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 not equal to "Z" AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN ("A", "1", "C", "3") AND CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0" AND CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is not null AND CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT is not equal to "0" and is not null then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT.
05/29/2020	2.4.0	RULE-7284	ADD	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to "Z" AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN ("A", "1", "C", "3") AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" AND CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not null AND CLAIM-HEADER-RECORD-OT.TOT-ALLOWED-AMT is not equal to "0" and is not null then CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-OT.TOT-ALLOWED-AMT'
05/29/2020	2.4.0	RULE-7285	ADD	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to "Z" AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN ("A", "1") AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" AND CLAIM-HEADER-RECORD-OT.PAYMENT-LEVEL-IND is equal to "2" AND CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT is not null AND CLAIM-LINE-RECORD-OT.ALLOWED-AMT is not equal to "0" and is not null then CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT is less than or equal to CLAIM-LINE-RECORD-OT.ALLOWED-AMT'
09/11/2020	2.4.0	Rule-7349	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-OT has a non-null value for PLACE-OF-SERVICE and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE
09/11/2020	2.4.0	Rule-7351	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to the following: '1', '3', 'A', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL and CLAIM-HEADER-RECORD-OT has a non-null value for PLACE-OF-SERVICE'
09/11/2020	2.4.0	Rule-7352	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and TYPE-OF-CLAIM is equal to the following: '1', '3', 'A', 'C' and CLAIM-HEADER-RECORD-OT.TYPE-OF-BILL has a non-null value, then CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE'
09/11/2020	2.4.0	Rule-7353	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and TYPE-OF-CLAIM is equal to the following: '1', '3', 'A', 'C' and CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL'
09/11/2020	2.4.0	Rule-7354	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and TYPE-OF-CLAIM is equal to the following: '1', '3', 'A', 'C' then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE and CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE'
09/11/2020	2.4.0	Rule-7356	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','A', '3','C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR is equal to '0' then CLAIM-LINE-RECORD-RX has a non-null value for DAYS-SUPPLY'
09/11/2020	2.4.0	Rule-7357	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','A', '3','C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR is equal to '0' then CLAIM-LINE-RECORD-RX has a non-null value for OT-RX-CLAIM-QUANTITY-ACTUAL'
08/21/2020	2.4.0	RULE-7313	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-IP.RECORD-ID is equal to 'CIP00002' then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADJUDICATION-DATE'
08/21/2020	2.4.0	RULE-7314	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-LT.RECORD-ID is equal to 'CLT00002' then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for ADJUDICATION-DATE'
08/21/2020	2.4.0	RULE-7315	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-OT.RECORD-ID is equal to 'COT00002' then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ADJUDICATION-DATE'
08/21/2020	2.4.0	RULE-7316	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-RX.RECORD-ID is equal to 'CRX00002' then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for ADJUDICATION-DATE'
08/21/2020	2.4.0	RULE-7317	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-LINE-RECORD-IP.RECORD-ID is equal to 'CIP00003' then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for ADJUDICATION-DATE'
08/21/2020	2.4.0	RULE-7318	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-LINE-RECORD-LT.RECORD-ID is equal to 'CLT00003' then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for ADJUDICATION-DATE'
08/21/2020	2.4.0	RULE-7319	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-LINE-RECORD-OT.RECORD-ID is equal to 'COT00003' then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ADJUDICATION-DATE'
08/21/2020	2.4.0	RULE-7320	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-LINE-RECORD-RX.RECORD-ID is equal to 'CRX00003' then CLAIM-LINE-RECORD-RX has a non-null and not invalidly formatted value for ADJUDICATION-DATE'
08/21/2020	2.4.0	RULE-7321	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.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE'
08/21/2020	2.4.0	RULE-7322	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE'
08/21/2020	2.4.0	RULE-7323	ADD	Data Dictionary - Validation Rules	N/A	'if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE'
08/21/2020	2.4.0	RULE-7324	ADD	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE'
04/17/2020	2.4.0	RULE-7208	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 is NOT in (Z)AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is NOT in ("26","026","87","087", "542","585", "654", "686")AND CLAIM-HEADER-RECORD-IP.ADJUSTEMENT-IND does not equal '1'THEN CLAIM-HEADER-IP.ADMISSION-DATE must have a valid non-null value	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', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C"), then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE'
04/17/2020	2.4.0	RULE-7209	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 to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN ('Z') AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654", "686") AND CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654", "686") AND CLAIM-HEADER-RECORD-IP.ADJUSTEMENT-IND does not equal '1' THEN CLAIM-LINE-IP.BEGINNING-DATE-OF-SERVICE must have a valid non-null value	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', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', and TYPE-OF-CLAIM in ("1","3","A","C") then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
04/17/2020	2.4.0	RULE-7210	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 to '0'AND CLAIM-F3HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN ('Z')AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654", "686")AND CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654", "686")AND CLAIM-HEADER-RECORD-IP.ADJUSTEMENT-IND does not equal '1'THEN CLAIM-LINE-IP.ENDING-DATE-OF-SERVICE must have a valid non-null value	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', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', and TYPE-OF-CLAIM in ("1","3","A","C") then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
04/17/2020	2.4.0	RULE-7211	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', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.PATIENT-STATUS does not equal '30', then CLAIM-HEADER-RECORD-IP has a valid, non-null value for DISCHARGE-DATE'	'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', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.PATIENT-STATUS does not equal '30' and TYPE-OF-CLAIM in ("1","3","A","C"), then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for DISCHARGE-DATE'
04/17/2020	2.4.0	RULE-7212	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 is NOT in (Z)AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is NOT in ("26","026","87","087", "542","585", "654", "686")AND CLAIM-HEADER-RECORD-LT.ADJUSTEMENT-IND does not equal '1'THEN CLAIM-HEADER-LT.BEGINNING-DATE-OF-SERVICE must have a valid non-null value	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.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C"), then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
04/17/2020	2.4.0	RULE-7213	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 is NOT in (Z)AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is NOT in ("26","026","87","087", "542","585", "654", "686")AND CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'THEN CLAIM-HEADER-LT.ENDING-DATE-OF-SERVICE must have a valid non-null value	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.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C"), then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
04/17/2020	2.4.0	RULE-7214	UPDATE	Data Dictionary - Validation Rules	IF CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is NOT in (Z)AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is NOT in ("26","026","87","087", "542","585", "654", "686")AND CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1'THEN CLAIM-HEADER-RX.PRESCRIPTION-FILL-DATE must have a valid non-null value	IF CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is NOT in (Z)AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is NOT in ("26","026","87","087", "542","585", "654", "686") AND CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C") THEN CLAIM-HEADER-RX.PRESCRIPTION-FILL-DATE must have a valid, non-null and not invalidly formatted value
04/17/2020	2.4.0	RULE-7215	UPDATE	Data Dictionary - Validation Rules	IF CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is NOT in (Z)AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is NOT in ("26","026","87","087", "542","585", "654", "686")AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'THEN CLAIM-HEADER-OT.BEGINNING-DATE-OF-SERVICE must have a valid non-null value	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C","2","B"), then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
04/17/2020	2.4.0	RULE-7216	UPDATE	Data Dictionary - Validation Rules	IF CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is NOT in (Z)AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is NOT in ("26","026","87","087", "542","585", "654", "686")AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'THEN CLAIM-HEADER-OT.ENDING-DATE-OF-SERVICE must have a valid non-null value	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C","2","B"), then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
04/17/2020	2.4.0	RULE-7217	UPDATE	Data Dictionary - Validation Rules	IF (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0'AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN ('Z')AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654", "686")AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654", "686")AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'THEN CLAIM-LINE-OT.BEGINNING-DATE-OF-SERVICE must have a valid non-null value	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C","2","B"), then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
04/17/2020	2.4.0	RULE-7218	UPDATE	Data Dictionary - Validation Rules	IF (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0'AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN ('Z')AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654", "686")AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654", "686")AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'THEN CLAIM-LINE-OT.ENDING-DATE-OF-SERVICE must have a valid non-null value	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C","2","B") then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
04/17/2020	2.4.0	RULE-7252	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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C"), then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
04/17/2020	2.4.0	RULE-7253	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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C"), then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
05/08/2020	2.4.0	RULE-7254	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', '686' then CLAIM-LINE-RECORD-IP has a non-null value for TYPE-OF-CLAIM'
05/08/2020	2.4.0	RULE-7255	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' then CLAIM-LINE-RECORD-LT has a non-null value for TYPE-OF-CLAIM'
05/08/2020	2.4.0	RULE-7256	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' then CLAIM-LINE-RECORD-OT has a non-null value for TYPE-OF-CLAIM'
05/08/2020	2.4.0	RULE-7257	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' then CLAIM-LINE-RECORD-RX has a non-null value for TYPE-OF-CLAIM'
05/08/2020	2.4.0	RULE-7258	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', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-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 "0" or "4" and TYPE-OF-CLAIM in ("1","3","A","C") then CLAIM-LINE-RECORD-IP has a non-null value for TYPE-OF-SERVICE'
05/08/2020	2.4.0	RULE-7259	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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0" or "4" and TYPE-OF-CLAIM in ("1","3","A","C") then CLAIM-LINE-RECORD-LT has a non-null value for TYPE-OF-SERVICE'
05/08/2020	2.4.0	RULE-7260	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" or "4" and TYPE-OF-CLAIM in ("1","3","A","C") then CLAIM-LINE-RECORD-OT has a non-null value for TYPE-OF-SERVICE'
05/08/2020	2.4.0	RULE-7261	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0" or "4" and TYPE-OF-CLAIM in ("1","3","A","C") then CLAIM-LINE-RECORD-RX has a non-null value for TYPE-OF-SERVICE'
05/08/2020	2.4.0	RULE-7262	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', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-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 "0" or "4" and TYPE-OF-CLAIM in ("1","A") then CLAIM-LINE-RECORD-IP has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'
05/08/2020	2.4.0	RULE-7263	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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0" or "4" and TYPE-OF-CLAIM in ("1","A") then CLAIM-LINE-RECORD-LT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'
05/08/2020	2.4.0	RULE-7264	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" or "4" and TYPE-OF-CLAIM in ("1","A","2","B") then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'
05/08/2020	2.4.0	RULE-7265	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0" or "4" and TYPE-OF-CLAIM in ("1","A") then CLAIM-LINE-RECORD-RX has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'
06/19/2020	2.4.0	RULE-7301	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', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM
06/19/2020	2.4.0	RULE-7302	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 one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM
06/19/2020	2.4.0	RULE-7303	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM
06/19/2020	2.4.0	RULE-7304	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM
06/19/2020	2.4.0	RULE-7305	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', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NUM
06/19/2020	2.4.0	RULE-7306	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 one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NUM
06/19/2020	2.4.0	RULE-7307	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM
06/19/2020	2.4.0	RULE-7308	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NUM
06/19/2020	2.4.0	RULE-7309	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', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' 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: '1','3','A','C' then CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NPI-NUM
06/19/2020	2.4.0	RULE-7310	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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' then CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NPI-NUM
06/19/2020	2.4.0	RULE-7311	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' then CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NPI-NUM
06/19/2020	2.4.0	RULE-7312	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-RX has non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI
09/11/2020	2.4.0	RULE-7358	ADD	Data Dictionary - Validation Rules	N/A	if PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE-PROV-ID has a non-null value then PROV-ATTRIBUTES-MAIN has a non-null value for FACILITY-GROUP-INDIVIDUAL-CODE'
09/11/2020	2.4.0	RULE-7359	ADD	Data Dictionary - Validation Rules	N/A	if PROV-IDENTIFIERS.SUBMITTING-STATE-PROV-ID has a non-null value then PROV-IDENTIFIERS has a non-null value for PROV-IDENTIFIER'
09/11/2020	2.4.0	RULE-7360	ADD	Data Dictionary - Validation Rules	N/A	if PROV-IDENTIFIERS.SUBMITTING-STATE-PROV-ID has a non-null value then PROV-IDENTIFIERS has a non-null and not invalidly formatted value for PROV-IDENTIFIER-EFF-DATE'
09/11/2020	2.4.0	RULE-7361	ADD	Data Dictionary - Validation Rules	N/A	if PROV-IDENTIFIERS.SUBMITTING-STATE-PROV-ID has a non-null value then PROV-IDENTIFIERS has a non-null value for PROV-IDENTIFIER-ISSUING-ENTITY-ID'
09/11/2020	2.4.0	RULE-7362	ADD	Data Dictionary - Validation Rules	N/A	if PROV-IDENTIFIERS.SUBMITTING-STATE-PROV-ID has a non-null value then PROV-IDENTIFIERS has a non-null value for PROV-IDENTIFIER-TYPE'
09/11/2020	2.4.0	RULE-7363	ADD	Data Dictionary - Validation Rules	N/A	if PROV-TAXONOMY-CLASSIFICATION.SUBMITTING-STATE-PROV-ID has a non-null value then PROV-TAXONOMY-CLASSIFICATION has a non-null value for PROV-CLASSIFICATION-CODE'
09/11/2020	2.4.0	RULE-7364	ADD	Data Dictionary - Validation Rules	N/A	if PROV-TAXONOMY-CLASSIFICATION.SUBMITTING-STATE-PROV-ID has a non-null value then PROV-TAXONOMY-CLASSIFICATION has a non-null value for PROV-CLASSIFICATION-TYPE'
06/24/2022	3.0.0	CIP249/ REVENUE-CENTER-QUANTITY-ACTUAL	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CIP249\|IP-LT-QUANTITY-OF-SERVICE-ACTUAL	DE No\|Data Element Name CIP249\|REVENUE-CENTER-QUANTITY-ACTUAL
06/24/2022	3.0.0	CIP250/ REVENUE-CENTER-QUANTITY-ALLOWED	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CIP250\|IP-LT-QUANTITY-OF-SERVICE-ALLOWED	DE No\|Data Element Name CIP250\|REVENUE-CENTER-QUANTITY-ALLOWED
06/24/2022	3.0.0	CLT202/ REVENUE-CENTER-QUANTITY-ACTUAL	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CLT202\|IP-LT-QUANTITY-OF-SERVICE-ACTUAL	DE No\|Data Element Name CLT202\|REVENUE-CENTER-QUANTITY-ACTUAL
06/24/2022	3.0.0	CLT203/ REVENUE-CENTER-QUANTITY-ALLOWED	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CLT203\|IP-LT-QUANTITY-OF-SERVICE-ALLOWED	DE No\|Data Element Name CLT203\|REVENUE-CENTER-QUANTITY-ALLOWED
06/24/2022	3.0.0	COT184	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION\|CODING REQUIREMENT COT184\|OT-RX-CLAIM-QUANTITY-ALLOWED\|The maximum allowable quantity of a drug or service that may be dispensed per prescription per date of service or per month. Quantity limits are applied to medications when the majority of appropriate clinical utilizations will be addressed within the quantity allowed.\|For use with CLAIMOT and CLAIMRX claims. For CLAIMIP and CLAIMOT claims/encounter records, use the IP-LT-QUANTITY-OF-SERVICE field. NOTE: One prescription for 100 250 milligram tablets results in OT-RX-CLAIM-QUANTITY-ALLOWED =100.This field is only applicable when the service being billed can be quantified in discrete units, e.g., a number of visits or the number of units of a prescription/refill that were filled. For prescriptions/refills, use the Medicaid Drug Rebate definition of a unit, which is the smallest unit by which the drug is normally measured; e.g. tablet, capsule, milliliter, etc. For drugs not identifiable or dispensed by a normal unit, e.g. powder filled vials, use 1 as the number of units.The value in OT-RX-CLAIM-QUANTITY-ALLOWED must correspond with the value in UNIT-OF-MEASURE.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION\|CODING REQUIREMENT COT184\|SERVICE-QUANTITY-ALLOWED\|The maximum allowable quantity of a service that may be rendered per date of service or per month.\|For use with CLAIMOT and CLAIMRX claims. For CLAIMIP and CLAIMOT claims/encounter records, use the IP-LT-QUANTITY-OF-SERVICE field. NOTE: One prescription for 100 250 milligram tablets results in OT-RX-CLAIM-QUANTITY-ALLOWED =100.This field is only applicable when the service being billed can be quantified in discrete units, e.g., a number of visits or the number of units of a prescription/refill that were filled. For prescriptions/refills, use the Medicaid Drug Rebate definition of a unit, which is the smallest unit by which the drug is normally measured; e.g. tablet, capsule, milliliter, etc. For drugs not identifiable or dispensed by a normal unit, e.g. powder filled vials, use 1 as the number of units.The value in OT-RX-CLAIM-QUANTITY-ALLOWED must correspond with the value in UNIT-OF-MEASURE.
06/24/2022	3.0.0	COT183	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name COT183\|OT-RX-CLAIM-QUANTITY-ACTUAL	DE No\|Data Element Name COT183\|SERVICE-QUANTITY-ACTUAL
06/24/2022	3.0.0	COT184	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name COT184\|OT-RX-CLAIM-QUANTITY-ACTUAL	DE No\|Data Element Name COT184\|SERVICE-QUANTITY-ALLOWED
06/24/2022	3.0.0	CRX132	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|NECESSITY\|DEFINITION \|CODING REQUIREMENT CRX132\|OT-RX-CLAIM-QUANTITY-ACTUAL\|\|The quantity of a drug, service, or product that is rendered/dispensed for a prescription, specific date of service, or billing time span.\|The value in OT-RX-CLAIM-QUANTITY-ACTUAL must correspond with the value in UNIT-OF-MEASURE.	\|DE NO\| DATA ELEMENT NAME\|NECESSITY\|DEFINITION \|CODING REQUIREMENT CRX132\|PRESCRIPTION-QUANTITY-ACTUAL\|\|The quantity of a drug that is dispensed for a prescription as reported by National Drug Code on the claim line.\|The value in PRESCRIPTION-QUANTITY-ACTUAL must correspond with the value in UNIT-OF-MEASURE.
06/24/2022	3.0.0	CRX131	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|NECESSITY\|DEFINITION \|CODING REQUIREMENT CRX131\|OT-RX-CLAIM-QUANITY-ALLOWED\|\|The maximum allowable quantity of a drug or service that may be dispensed per prescription per date of service or per month. Quantity limits are applied to medications when the majority of appropriate clinical utilizations will be addressed within the quantity allowed.\|NOTE: One prescription for 100 250 milligram tablets results in OT-RX-CLAIM-QUANTITY-ALLOWED =100.	\|DE NO\| DATA ELEMENT NAME\|NECESSITY\|DEFINITION \|CODING REQUIREMENT CRX131\|PRESCRIPTION-QUANTITY-ALLOWED\|\|The maximum allowable quantity of a drug that may be dispensed per prescription per date of service. Quantity limits are applied to medications when the majority of appropriate clinical utilizations will be addressed within the quantity allowed.\|NOTE: One prescription for 100 250 milligram tablets results in PRESCRIPTION-QUANTITY-ALLOWED =100.
06/24/2022	3.0.0	CRX132	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CRX132\|OT-RX-CLAIM-QUANTITY-ACTUAL	DE No\|Data Element Name CRX132\|PRESCRIPTION-QUANTITY-ACTUAL
06/24/2022	3.0.0	CRX131	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CRX131\|OT-RX-CLAIM-QUANITY-ALLOWED	DE No\|Data Element Name CRX131\|PRESCRIPTION-QUANTITY-ALLOWED
05/08/2020	2.4.0	CITIZENSHIP-VERIFICATION-FLAG (ELG041)	ADD	Data Dictionary - Valid Values	N/A	This data element conditionally required when the individual is a U.S. Citizen
05/08/2020	2.4.0	CITIZENSHIP-VERIFICATION-FLAG (ELG041)	UPDATE	Data Dictionary	Necessity \| Required	Necessity \| Conditional
05/29/2020	2.4.0	UNIT-OF-MEASURE (CRX133)	UPDATE	Data Dictionary	Code \| Description F2 \| International Unit GR \| Gram ML \| Milliliter ME \| Miligram UN \| Unit	Code \| Description EA \| Each F2 \| International Unit GM \| Grams GR \| Gram ML \| Milliliter ME \| Milligram UN \| Unit
05/08/2020	2.4.0	IMMIGRATION-VERIFICATION-FLAG (ELG043)	UPDATE	Data Dictionary - Valid Values	Code \| Description 1 \| Yes	Code \| Description 1 \| Enrolled in Medicaid pending citizenship verification
05/08/2020	2.4.0	IMMIGRATION-VERIFICATION-FLAG (ELG043)	UPDATE	Data Dictionary - Valid Values	Code \| Description 0 \| No	Code \| Description 0 \|Citizenship Verified
07/31/2020	2.4.0	DTL-METRIC-DEC-QTY (CRX144)	UPDATE	Data Dictionary	\|Data Element Name\|Coding Requirement\| \|DTL-METRIC-DEC-QTY\|Must be numeric\|	\|Data Element Name\|Coding Requirement\| \|DTL-METRIC-DEC-QTY\|Must be numeric. Only populate on compound drug claims. Should pass through the “Compound Ingredient Quantity” from the NCPDP claims form, field 448-ED.\|
12/13/2019	2.3.0	CONCEPTION-TO-BIRTH-IND (ELG094)	UPDATE	Data Dictionary	The CHIP-CODE must equal “3” (Individual was not Medicaid-Expansion CHIP eligible, but was included in a separate title XXI CHIP program) or “4” (Individual was both Medicaid eligible and Separate CHIP eligible.)	The CHIP-CODE must equal “3” (Individual was not Medicaid-Expansion CHIP eligible, but was included in a separate title XXI CHIP program).
12/04/2020	2.4.0	RULE-2820	UPDATE	Data Dictionary - Validation Rules	'if PROV-ATTRIBUTES-MAIN has a valid, non-null value for DATE-OF-BIRTH and FILE-HEADER-RECORD-PROVIDER has a valid, non-null value for END-OF-TIME-PERIOD and FILE-HEADER-RECORD-PROVIDER has a valid, non-null value for START-OF-TIME-PERIOD, then the difference between dates PROV-ATTRIBUTES-MAIN.DATE-OF-BIRTH and FILE-HEADER-RECORD-PROVIDER.START-OF-TIME-PERIOD is less than or equal to 85 years and the difference between dates PROV-ATTRIBUTES-MAIN.DATE-OF-BIRTH and FILE-HEADER-RECORD-PROVIDER.START-OF-TIME-PERIOD is greater than or equal to 18 years'	if PROV-ATTRIBUTES-MAIN segments with PROV-ATTRIBUTES-MAIN has a non-null and not invalidly formatted value for DATE-OF-BIRTH and FILE-HEADER-RECORD-PROVIDER has a non-null and not invalidly formatted value for START-OF-TIME-PERIOD and FILE-HEADER-RECORD-PROVIDER has a non-null and not invalidly formatted value for END-OF-TIME-PERIOD and for every record of type PROV-ATTRIBUTES-MAIN there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys and PROV-ATTRIBUTES-MAIN has a null value for DATE-OF-DEATH and PROV-MEDICAID-ENROLLMENT-STATUS-CODE is not equal to one of the following: ‘60’, ‘61’, ‘62’. ‘63’, ‘64’, ‘65’, ‘66’, ‘67’, ‘68’, ‘69’, ‘70’, ‘71’, ‘72’, ‘73’, ‘74’, ‘75’, ‘76’, ‘77’, ‘78’, ‘79’, ‘80’, ‘81’, ‘82’, ‘83’ then the difference between dates PROV-ATTRIBUTES-MAIN.DATE-OF-BIRTH and FILE-HEADER-RECORD-PROVIDER.START-OF-TIME-PERIOD is less than or equal to 85 years and the difference between dates PROV-ATTRIBUTES-MAIN.DATE-OF-BIRTH and FILE-HEADER-RECORD-PROVIDER.START-OF-TIME-PERIOD is greater than or equal to 18 years'
06/19/2020	2.4.0	RULE-1656	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '131', '134', '135', '136', '137''	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '127','131', '134', '135', '136', '137', '138', '139', '140', '141', '142', '143', '144'"
03/27/2020	2.4.0	ELG-IDENTIFIERS-ELG00022	ADD	Data Dictionary - File Segment	N/A	\|Data Element Name \| DE No\| Size\| \|RECORD-ID\|ELG257\|X(8)\| \|SUBMITTING-STATE\|ELG258\|X(2)\| \|RECORD-NUMBER\|ELG259\|9(11)\| \|MSIS-IDENTIFICATION-NUM \|ELG260\|X(20)\| \|ELG-IDENTIFIER-TYPE\|ELG261\|X(1)\| \|ELG-IDENTIFIER-ISSUING-ENTITY-ID\|ELG262\|X(18)\| \|ELG-IDENTIFIER-EFF-DATE\|ELG263\|9(8)\| \|ELG-IDENTIFIER-END-DATE\|ELG264\|9(8)\| \|ELG-IDENTIFIER\|ELG265\|X(20)\| \|REASON-FOR-CHANGE\|ELG266\|X(10)\| \|STATE-NOTATION\|ELG267\|X(500)\| \|FILLER\|ELG268\|X(412)\|
03/27/2020	2.4.0	RULE-7238	ADD	Data Dictionary - Validation Rules	N/A	Value must be compatible with specified T-MSIS picture format: X(10)
03/27/2020	2.4.0	RULE-7233	ADD	Data Dictionary - Validation Rules	N/A	Value must be compatible with specified T-MSIS picture format: X(20)
03/27/2020	2.4.0	RULE-7234	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid date of the form CCYYMMDD
03/27/2020	2.4.0	RULE-7232	ADD	Data Dictionary - Validation Rules	N/A	Value must be compatible with specified T-MSIS picture format: X(500)
03/27/2020	2.4.0	RULE-7224	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid date of the form CCYYMMDD
03/27/2020	2.4.0	RULE-7241	ADD	Data Dictionary - Validation Rules	N/A	Value must be compatible with specified T-MSIS picture format: X(18)
03/27/2020	2.4.0	RULE-7236	ADD	Data Dictionary - Validation Rules	N/A	Value must be compatible with specified T-MSIS picture format: X(20)
03/27/2020	2.4.0	RULE-7229	ADD	Data Dictionary - Validation Rules	N/A	Value must be compatible with specified T-MSIS picture format: X(8)
03/27/2020	2.4.0	RULE-7230	ADD	Data Dictionary - Validation Rules	N/A	Value must be compatible with specified T-MSIS picture format: X(2)
03/27/2020	2.4.0	RULE-7231	ADD	Data Dictionary - Validation Rules	N/A	Value must be compatible with specified T-MSIS picture format: X(1)
03/27/2020	2.4.0	RULE-7235	ADD	Data Dictionary - Validation Rules	N/A	Value must be compatible with specified T-MSIS picture format: 9(11)
03/27/2020	2.4.0	RULE-7239	ADD	Data Dictionary - Validation Rules	N/A	'If the field is populated, the value must be contained in the set of valid values with id: 'REASON-FOR-CHANGE' and (if ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE is non-null then ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE >= Valid Values Effective-Date and ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE <= Valid Values End-Date)'
03/27/2020	2.4.0	RULE-7220	ADD	Data Dictionary - Validation Rules	N/A	'If the field is populated, the value must be contained in the set of valid values with id: 'ELG-IDENTIFIER-TYPE' and (if ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE is non-null then ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE >= Valid Values Effective-Date and ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE <= Valid Values End-Date)'
03/27/2020	2.4.0	RULE-7219	ADD	Data Dictionary - Validation Rules	N/A	'If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and (if ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE is non-null then ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE >= Valid Values Effective-Date and ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE <= Valid Values End-Date)'
03/27/2020	2.4.0	RULE-7227	ADD	Data Dictionary - Validation Rules	N/A	'if ELG-IDENTIFIERS has a valid, non-null value for ELG-IDENTIFIER, then ELG-IDENTIFIERS.ELG-IDENTIFIER does not contain any pipe (\|) or asterisk (*) characters'
03/27/2020	2.4.0	RULE-7242	ADD	Data Dictionary - Validation Rules	N/A	'if ELG-IDENTIFIERS has a valid, non-null value for STATE-NOTATION, then ELG-IDENTIFIERS.STATE-NOTATION does not contain any pipe (\|) or asterisk (*) characters'
03/27/2020	2.4.0	RULE-7222	ADD	Data Dictionary - Validation Rules	N/A	Field RECORD-NUMBER should be unique across all records of type ELG-IDENTIFIERS
03/27/2020	2.4.0	RULE-7228	ADD	Data Dictionary - Validation Rules	N/A	'if ELG-IDENTIFIERS has a valid, non-null value for ELG-IDENTIFIER, then ELG-IDENTIFIERS has a valid, non-null value for ELG-IDENTIFIER-TYPE'
03/27/2020	2.4.0	RULE-7225	ADD	Data Dictionary - Validation Rules	N/A	'if ELG-IDENTIFIERS has a valid, non-null value for ELG-IDENTIFIER-EFF-DATE and ELG-IDENTIFIERS has a valid, non-null value for ELG-IDENTIFIER-END-DATE, then ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE is less than or equal to ELG-IDENTIFIERS.ELG-IDENTIFIER-END-DATE'
03/27/2020	2.4.0	RULE-7226	ADD	Data Dictionary - Validation Rules	N/A	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE
02/21/2020	2.4.0	RULE-768	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-IP has corresponding parent record CLAIM-HEADER-RECORD-IP Join Keys between Claim Header and Line segment: SUBMITTING-STATE ICN-ORIG ICN-ADJ ADJUDICATION-DATE/	if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-IP has corresponding parent record CLAIM-HEADER-RECORD-IP Join Keys between Claim Header and Line segment: SUBMITTING-STATE ICN-ORIG ICN-ADJ ADJUDICATION-DATE ADJUSTMENT-IND (LINE-ADJUSTMENT-IND)
02/21/2020	2.4.0	RULE-1204	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-LT has corresponding parent record CLAIM-HEADER-RECORD-LT Join Keys between Claim Header and Line segment: SUBMITTING-STATE ICN-ORIG ICN-ADJ ADJUDICATION-DATE	if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-LT has corresponding parent record CLAIM-HEADER-RECORD-LT Join Keys between Claim Header and Line segment: SUBMITTING-STATE ICN-ORIG ICN-ADJ ADJUDICATION-DATE ADJUSTMENT-IND (LINE-ADJUSTMENT-IND)
02/21/2020	2.4.0	RULE-1610	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-OT has corresponding parent record CLAIM-HEADER-RECORD-OT Join Keys between Claim Header and Line segment: SUBMITTING-STATE ICN-ORIG ICN-ADJ ADJUDICATION-DATE	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-OT has corresponding parent record CLAIM-HEADER-RECORD-OT Join Keys between Claim Header and Line segment: SUBMITTING-STATE ICN-ORIG ICN-ADJ ADJUDICATION-DATE ADJUSTMENT-IND (LINE-ADJUSTMENT-IND)
02/21/2020	2.4.0	RULE-1909	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-RX has corresponding parent record CLAIM-HEADER-RECORD-RX Join Keys between Claim Header and Line segment: SUBMITTING-STATE ICN-ORIG ICN-ADJ ADJUDICATION-DATE	if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-RX has corresponding parent record CLAIM-HEADER-RECORD-RX SUBMITTING-STATE ICN-ORIG ICN-ADJ ADJUDICATION-DATE ADJUSTMENT-IND (LINE-ADJUSTMENT-IND)
03/27/2020	2.4.0	ELG-IDENTIFIERS	ADD	Data Dictionary	N/A	Update Data Dictionary document for ELG-IDENTIFIERS segment Update Data Dictionary Appendices document for ELG-IDENTIFIER-TYPE data element Update Data Dictionary Data Validation Rule document with all rules of ELG-IDENTIFIERS segment Update Data Dictionary Record Layout for ELG-IDENTIFIERS Update Data Dictionary Segment Relationship doc for ELG-IDENTIFIERS
03/27/2020	2.4.0	RULE-7240	ADD	Data Dictionary - Validation Rules	N/A	'if ELG-IDENTIFIERS has a valid, non-null value for SUBMITTING-STATE and FILE-HEADER-RECORD-ELIGIBILITY has a valid, non-null value for SUBMITTING-STATE, then ELG-IDENTIFIERS.SUBMITTING-STATE refers to the same state as FILE-HEADER-RECORD-ELIGIBILITY.SUBMITTING-STATE'
03/27/2020	2.4.0	REASON-FOR-CHANGE	ADD	Data Dictionary - Valid Values	N/A	MERGE - Merge Beneficiaries UNMERGE - Unmerge Beneficiaries LSE - Large System Enhancement TCAM - Transition between CHIP and Medicaid
04/17/2020	2.4.0	ELG083	UPDATE	Data Dictionary	If multiple MSIS-CASE-NUMs exist at the state-level, and T-MSIS only allows one Case Number in current T-MSIS DD, please enter the Case Number with the longest eligibility days in that particular month.	N/A
04/17/2020	2.4.0	CRX129	UPDATE	Data Dictionary	Necessity \| Required	Necessity \| Conditional
04/17/2020	2.4.0	COT123	UPDATE	Data Dictionary	PLACE-OF-SERVICE (COT123): A code indicating where the service was performed. CMS 1500 values are used for this data element.	PLACE-OF-SERVICE (COT123): A data element corresponding with line 24b on the CMS-1500 that indicates where the services took place. This is a pass-through data element that should not be modified or derived when missing unless otherwise specified.
04/17/2020	2.4.0	COT123	UPDATE	Data Dictionary	Coding Requirement \| Leave field blank for capitation or premium payments (TYPE-OF-SERVICE = 119, 120, 121, 122)	PLACE-OF-SERVICE (COT123): “A data element corresponding with line 24b on the CMS-1500 that indicates where the services took place. This is a pass-through data element that should not be modified or derived when missing unless otherwise specified.”
06/24/2022	3.0.0	CIP270/ XIX-MBESCBES-CATEGORY-OF-SERVICE	Modify DE Width	Data Dictionary - Record Layout	SIZE X(4)	SIZE X(5)
06/24/2022	3.0.0	CLT224/ XIX-MBESCBES-CATEGORY-OF-SERVICE	Modify DE Width	Data Dictionary - Record Layout	SIZE X(4)	SIZE X(5)
06/24/2022	3.0.0	COT211/ XIX-MBESCBES-CATEGORY-OF-SERVICE	Modify DE Width	Data Dictionary - Record Layout	SIZE X(4)	SIZE X(5)
06/24/2022	3.0.0	CRX150/ XIX-MBESCBES-CATEGORY-OF-SERVICE	Modify DE Width	Data Dictionary - Record Layout	SIZE X(4)	SIZE X(5)
05/08/2020	2.4.0	RESTRICTED-BENEFITS-CODE (ELG097)	UPDATE	Data Dictionary - Valid Values	Individual is eligible for Medicaid and entitled to benefits under the Psychiatric Residential Treatment Facilities Demonstration Grant Program (PRTF), as enacted by the Deficit Reduction Act of 2005. PRTF grants assist States to help provide community alternatives to psychiatric resident treatment facilities for children.	Individual is eligible for Medicaid and entitled to benefits under the Psychiatric Residential Treatment Facilities Demonstration Grant Program (PRTF), as enacted by the Deficit Reduction Act of 2005.
05/08/2020	2.4.0	RESTRICTED-BENEFITS-CODE (ELG097)	UPDATE	Data Dictionary - Valid Values	Individual is eligible for Medicaid or CHIP but only entitled to restricted benefits for pregnancy-related services.	Individual is eligible for Medicaid or CHIP but is only entitled to restricted benefits for pregnancy-related services, including services that do and those that do not meet the Minimum Essential Coverage standard.
05/08/2020	2.4.0	RESTRICTED-BENEFITS-CODE (ELG097)	UPDATE	Data Dictionary - Valid Values	Individual is eligible for Medicaid or Medicaid-Expansion CHIP but, for reasons other than alien, dual-eligibility or pregnancy-related status, is only entitled to restricted benefits (e.g., restricted benefits based upon substance abuse, medically needy or other criteria).	Individual is eligible for Medicaid or Medicaid-Expansion CHIP, but for reasons other than alien, dual-eligibility, or pregnancy-related status, is only entitled to restricted benefits (e.g., restricted benefits based upon substance abuse, medically needy, or other criteria) that meet the standard for Minimum Essential Coverage.
05/08/2020	2.4.0	RESTRICTED-BENEFITS-CODE (ELG097)	ADD	Data Dictionary - Valid Values	N/A	Individual is eligible for Medicaid or Medicaid-Expansion CHIP, but for reasons other than alien, dual-eligibility, or pregnancy-related status, is only entitled to restricted benefits (e.g., restricted benefits based on substance abuse, medically needy, or other criteria) that do not meet the standard for Minimum Essential Coverage
06/19/2020	2.4.0	RULE-7209	UPDATE	Data Dictionary - Validation Rules	One Record Type(Single Record)	Two Record Type (1 to 1)
06/19/2020	2.4.0	RULE-7217	UPDATE	Data Dictionary - Validation Rules	One Record Type(Single Record)	Two Record Type (1 to 1)
06/19/2020	2.4.0	RULE-7218	UPDATE	Data Dictionary - Validation Rules	One Record Type(Single Record)	Two Record Type (1 to 1)
03/27/2020	2.4.0	ELG-IDENTIFIER-TYPE	ADD	Data Dictionary - Valid Values	N/A	Identifier Type Name 1 Medicaid Card ID 2 Old MSIS Identification Number
08/21/2020	2.4.0	MEDICAID-PAID-AMT (COT178)	UPDATE	Data Dictionary - Valid Values	\|DE\|Data Element Name\|Definition\|Coding Requirement\|CR NO\| \|COT178\|MEDICAID-PAID-AMT\|The amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim detail level.\| If TYPE-OF-CLAIM = 3, C, W (encounter record) this field should be populated with the amount that the provider billed the managed care plan.\|COT178-0001\|	\|COT178\|MEDICAID-PAID-AMT\|The amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim detail level.\|Not Applicable\|COT178-0001\|
07/10/2020	2.4.0	PAYMENT-LEVEL-IND (CIP132, CLT082, COT068, CRX058)	UPDATE	Data Dictionary	\|CR NO\|Coding Requirement\| \|CIP132-0002\|Payment fields at either the claim header or line on encounter records should be blank.\| \|CLT082-0002\|Payment fields at either the claim header or line on encounter records should be blank.\| \|COT068-0002\|Payment fields at either the claim header or line on encounter records should be blank.\| \|CRX058-0002\|Payment fields at either the claim header or line on encounter records should be blank.\|	\|CR NO\|Coding Requirement\| \|CIP132-0002\|Not Applicable\| \|CLT082-0002\|Not Applicable\| \|COT068-0002\|Not Applicable\| \|CRX058-0002\|Not Applicable\|
05/08/2020	2.4.0	TYPE-OF-CLAIM	UPDATE	Data Dictionary - Valid Values	Code \| Description Z \| Denied Claimes	N/A
04/17/2020	2.4.0	RESTRICTED-BENEFITS-CODE ELG097	ADD	Data Dictionary - Valid Values	N/A	Data Element Name\| DE ID\| Code\| Description\| Effective Date\| End Date\| RESTRICTED-BENEFITS-CODE\| ELG097\| F\| Individual is eligible for Medicaid but is only entitled to restricted benefits for medical assistance for COVID-19 diagnostic products and any visit described as a COVID–19 testing-related service for which payment may be made under the State plan during any portion of the public health emergency period, beginning March 18, 2020 as described in Sections 1902(a)(10)(A)(ii)(XXIII), 1902(ss) and clause XVIII in the matter following 1902(a)(10)(G) of the Social Security Act.\| 3/18/2020\| 12/31/9999\|
04/17/2020	2.4.0	PROGRAM-TYPE CIP129, CLT079, COT065, CRX055	ADD	Data Dictionary - Valid Values	N/A	Data Element Name\| DE ID\| Code\| Description\| Effective Date\| End Date\| PROGRAM-TYPE\| CIP129, CLT079, COT065, CRX055\| 17\| COVID-19 Testing Services (1905(a)(3) and 2103(c))\| 3/18/2020\| 12/31/9999\|
04/17/2020	2.4.0	TYPE-OF-SERVICE CIP257, CLT211, COT186, CRX134	ADD	Data Dictionary - Valid Values	N/A	Data Element Name\| DE ID\| Code\| Description\| Effective Date\| End Date\| TYPE-OF-SERVICE\| CIP257, CLT211, COT186, CRX134 \| 136\| In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal Regulations) administered during any portion of the emergency period defined in paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, and the administration of such in vitro diagnostic products\| 3/18/2020\| 12/31/9999\| TYPE-OF-SERVICE\| CIP257, CLT211, COT186, CRX134 \| 137\| COVID–19 testing-related services\|3/18/2020\| 12/31/9 999\|
04/17/2020	2.4.0	BENEFIT-TYPE CIP268, CLT218, COT209, CRX148	ADD	Data Dictionary - Valid Values	N/A	Data Element Name\| DE ID \|Code \|Description\| Effective Date\| End Date\| BENEFIT-TYPE \|CIP268, CLT218, COT209, CRX148\| 107\| In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal Regulations) administered during any portion of the emergency period defined in paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, and the administration of such in vitro diagnostic products\| 3/18/2020\| 12/31/9999\| BENEFIT-TYPE\| CIP268, CLT218, COT209, CRX148\| 108\| COVID–19 testing-related s ervices\| 3/18/2020\| 12/31/9999\|
04/17/2020	2.4.0	ELIGIBILITY-GROUP ELG087	ADD	Data Dictionary - Valid Values	N/A	Data Element Name\| DE ID\| Code\| Description\| Effective Date\| End Date\| ELIGIBILITY-GROUP\| ELG087\| 76\| Uninsured Individual eligible for COVID-19 testing\| 3/18/2020\| 12/31/9999\|
04/17/2020	2.4.0	RULE-807	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '001', '058', '060', '084', '086', '090', '091', '092', '093', '123', '132', '135''	if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '001', '058', '060', '084', '086', '090', '091', '092', '093', '123', '132', '135','136','137''
04/17/2020	2.4.0	RULE-1244	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '009', '044', '045', '046', '047', '048', '050', '059', '133''	if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '009', '044', '045', '046', '047', '048', '050', '059', '133','136','137''
04/17/2020	2.4.0	RULE-1656	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '087', '088', '089', '115', '119', '120', '121', '122', '131', '134', '135''	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '087', '088', '089', '115', '119', '120', '121', '122', '131', '134', '135','136','137''
04/17/2020	2.4.0	RULE-1938	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '011', '018', '033', '034', '036', '085', '089', '127', '131''	if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '011', '018', '033', '034', '036', '085', '089', '127', '131','136','137''
07/10/2020	2.4.0	VETERAN-IND (ELG039)	UPDATE	Data Dictionary	\|Definition\|Necessity\|Coding Requirement\| \|A flag indicating if the individual served in the active military, naval or air service\|Required\|Value must be equal to a valid value.\|	\|Definition\|Necessity\|Coding Requirement\| A flag indicating if a non-citizen is exempt from the 5-year bar on benefits because they are a veteran or an active member of the military, naval or air service\|Conditional\|this field should only be populated for beneficiaries who have a non-citizen IMMIGRATION-STATUS (i.e., IMMIGRATION-STATUS = “1”, “2”, or “3”).\|
07/31/2020	2.4.0	RULE-559	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and (CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '0' or CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W'), then CLAIM-HEADER-RECORD-IP.MEDICARE-COMB-DED-IND equals '0''	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '0' then CLAIM-HEADER-RECORD-IP.MEDICARE-COMB-DED-IND equals '0''
07/31/2020	2.4.0	RULE-998	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and (CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0' or CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W'), then CLAIM-HEADER-RECORD-LT.MEDICARE-COMB-DED-IND equals '0''	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and (CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0' then CLAIM-HEADER-RECORD-LT.MEDICARE-COMB-DED-IND equals '0''
07/31/2020	2.4.0	RULE-1417	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and (CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' or CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W'), then CLAIM-HEADER-RECORD-OT.MEDICARE-COMB-DED-IND equals '0''	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' then CLAIM-HEADER-RECORD-OT.MEDICARE-COMB-DED-IND equals '0''
07/31/2020	2.4.0	RULE-1971	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and (CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' or CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W'), then CLAIM-HEADER-RECORD-RX.MEDICARE-COMB-DED-IND equals '0''	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' then CLAIM-HEADER-RECORD-RX.MEDICARE-COMB-DED-IND equals '0'.
05/29/2020	2.4.0	RULE-2068	UPDATE	Data Dictionary - Validation Rules	'if ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND equals '1', then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '3', '4''	'if ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND equals '1', then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '3'"
07/31/2020	2.4.0	RULE-7293	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to the following values: '26', '026', '87', '087', '542', '585', '654' and For every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type CLAIM-LINE-RECORD-OT that matches on the join keys (SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND=LINE-ADJSTMT-IND) and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to the following values: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE-FLAG then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE'
07/31/2020	2.4.0	RULE-7294	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to the following values: '26', '026', '87', '087', '542', '585', '654' and For every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type CLAIM-LINE-RECORD-OT that matches on the join keys (SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND=LINE-ADJSTMT-IND) and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to the following values: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE, then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE-FLAG'
07/31/2020	2.4.0	RULE-7287	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 has a non-null value for PROCEDURE-CODE-1 then CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-FLAG-1'
07/31/2020	2.4.0	RULE-7288	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 has a non-null value for PROCEDURE-CODE-2 then CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-FLAG-2'
07/31/2020	2.4.0	RULE-7289	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 has a non-null value for PROCEDURE-CODE-3 then CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-FLAG-3'
07/31/2020	2.4.0	RULE-7290	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 has a non-null value for PROCEDURE-CODE-4 then CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-FLAG-4'
07/31/2020	2.4.0	RULE-7291	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 has a non-null value for PROCEDURE-CODE-5 then CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-FLAG-5'
07/31/2020	2.4.0	RULE-7292	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 has a non-null value for PROCEDURE-CODE-6 then CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-FLAG-6'
06/19/2020	2.4.0	RULE-7295	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '138', '139', '140', '141', '142', '143' ,'144' AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' AND CLAIM-HEADER-RECORD-OT.MSIS-IDENTIFICATION-NUM is a valid, non-null value AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' then CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '2' or 'B'
06/19/2020	2.4.0	RULE-7296	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' AND CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to '138' then CLAIM-HEADER-RECORD-OT has a non-null value for 'HEALTH-HOME-ENTITY-NAME'
11/13/2020	2.4.0	RULE-7350	ADD	Data Dictionary - Validation Rules	N/A	(PROV-MEDICAID-ENROLLMENT Record segment with the distinct combination of SUBMITTING-STATE, SUBMITTING-STATE-PROV-ID, PROV-MEDICAID-ENROLLMENT-STATUS-CODE and STATE-PLAN-ENROLLMENT = 3) AND (PROV-MEDICAID-ENROLLMENT Record segment with the same distinct combination of SUBMITTING-STATE, SUBMITTING-STATE-PROV-ID, PROV-MEDICAID-ENROLLMENT-STATUS-CODE and STATE-PLAN-ENROLLMENT in (1,2)) must have non-overlapping date ranges.
12/04/2020	2.4.0	OCCURRENCE-CODE-01 to OCCURRENCE-CODE-10	UPDATE	Data Dictionary	OCCURRENCE-CODE-01 to OCCURRENCE-CODE-10 http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1104cp.pdf	OCCURRENCE-CODE-01 to OCCURRENCE-CODE-10 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1795A3.pdf
06/19/2020	2.4.0	RULE-2806	UPDATE	Data Dictionary - Validation Rules	if and only if PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03', then PROV-ATTRIBUTES-MAIN has a valid, non-null value for PROV-FIRST-NAME'	if PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03', then PROV-ATTRIBUTES-MAIN has a valid, non-null value for PROV-FIRST-NAME'
06/19/2020	2.4.0	RULE-2810	UPDATE	Data Dictionary - Validation Rules	'if and only if PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03', then PROV-ATTRIBUTES-MAIN has a valid, non-null value for PROV-LAST-NAME'	if PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03', then PROV-ATTRIBUTES-MAIN has a valid, non-null value for PROV-LAST-NAME'
06/19/2020	2.4.0	RULE-2817	UPDATE	Data Dictionary - Validation Rules	'if and only if PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03', then PROV-ATTRIBUTES-MAIN has a valid, non-null value for DATE-OF-BIRTH'	if PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03', then PROV-ATTRIBUTES-MAIN has a valid, non-null value for DATE-OF-BIRTH'
06/19/2020	2.4.0	RULE-414	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-1, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-1'	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-1, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-1'
06/19/2020	2.4.0	RULE-426	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-FLAG-2, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-2'	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-FLAG-2, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-2'
06/19/2020	2.4.0	RULE-480	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-6, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-6'	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-6, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-6'
06/19/2020	2.4.0	RULE-1121	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-LT has a valid, non-null value for WAIVER-TYPE, then CLAIM-HEADER-RECORD-LT has a valid, non-null value for WAIVER-ID'	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-LT has a valid, non-null value for WAIVER-TYPE, then CLAIM-HEADER-RECORD-LT has a valid, non-null value for WAIVER-ID'
06/19/2020	2.4.0	RULE-1234	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-LINE-RECORD-LT has a valid, non-null value for REVENUE-CODE, then CLAIM-LINE-RECORD-LT has a valid, non-null value for REVENUE-CHARGE'	'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-LINE-RECORD-LT has a valid, non-null value for REVENUE-CODE, then CLAIM-LINE-RECORD-LT has a valid, non-null value for REVENUE-CHARGE'
06/19/2020	2.4.0	RULE-1535	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-OT has a valid, non-null value for WAIVER-TYPE, then CLAIM-HEADER-RECORD-OT has a valid, non-null value for WAIVER-ID'	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-OT has a valid, non-null value for WAIVER-TYPE, then CLAIM-HEADER-RECORD-OT has a valid, non-null value for WAIVER-ID'
06/19/2020	2.4.0	RULE-1840	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-RX has a valid, non-null value for WAIVER-TYPE, then CLAIM-HEADER-RECORD-RX has a valid, non-null value for WAIVER-ID'	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-RX has a valid, non-null value for WAIVER-TYPE, then CLAIM-HEADER-RECORD-RX has a valid, non-null value for WAIVER-ID'
06/19/2020	2.4.0	RULE-2331	UPDATE	Data Dictionary - Validation Rules	'if and only if WAIVER-PARTICIPATION has a valid, non-null value for WAIVER-TYPE, then WAIVER-PARTICIPATION has a valid, non-null value for WAIVER-ID'	'if WAIVER-PARTICIPATION has a valid, non-null value for WAIVER-TYPE, then WAIVER-PARTICIPATION has a valid, non-null value for WAIVER-ID'
06/19/2020	2.4.0	RULE-439	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-3, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-3'	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-3, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-3'
06/19/2020	2.4.0	RULE-453	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-4, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-4''if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-4, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-4'	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-4, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-4'
06/19/2020	2.4.0	RULE-467	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-5, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-5'	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-5, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-5'
06/19/2020	2.4.0	RULE-683	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP has a valid, non-null value for WAIVER-TYPE, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for WAIVER-ID'	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a valid, non-null value for WAIVER-TYPE, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for WAIVER-ID'
06/19/2020	2.4.0	RULE-798	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-LINE-RECORD-IP has a valid, non-null value for REVENUE-CODE, then CLAIM-LINE-RECORD-IP has a valid, non-null value for REVENUE-CHARGE'	'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-LINE-RECORD-IP has a valid, non-null value for REVENUE-CODE, then CLAIM-LINE-RECORD-IP has a valid, non-null value for REVENUE-CHARGE'
08/21/2020	2.4.0	RULE-690	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-IP.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM and TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' then CLAIM-HEADER-RECORD-IP.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
08/21/2020	2.4.0	RULE-1127	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for BILLING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-LT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' then CLAIM-HEADER-RECORD-LT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
08/21/2020	2.4.0	RULE-1541	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-OT. TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' then CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
08/21/2020	2.4.0	RULE-1846	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-RX.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM and TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' then CLAIM-HEADER-RECORD-RX.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
08/21/2020	2.4.0	RULE-693	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' then If the CLAIM-HEADER-RECORD-IP.PROV-TAXONOMY is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''
08/21/2020	2.4.0	RULE-1130	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' then If the CLAIM-HEADER-RECORD-LT.PROV-TAXONOMY is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''
08/21/2020	2.4.0	RULE-1545	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' then If the CLAIM-HEADER-RECORD-OT.PROV-TAXONOMY is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''
08/21/2020	2.4.0	RULE-1849	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' then If the field is populated, the CLAIM-HEADER-RECORD-RX. BILLING-PROV-TAXONOMY must be contained in the set of valid values with id: 'PROV-TAXONOMY''
05/18/2018	2.2.0	RULE-572	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for NON-COV-DAYS and CLAIM-HEADER-RECORD-IP has a valid, non-null value for MEDICAID-COV-INPATIENT-DAYS, then the sum of CLAIM-HEADER-RECORD-IP.NON-COV-DAYS and CLAIM-HEADER-RECORD-IP.MEDICAID-COV-INPATIENT-DAYS is less than or equal to the number of days between the earliest CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE date and the latest CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE date', where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS does not equal '585'	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for NON-COV-DAYS and CLAIM-HEADER-RECORD-IP has a valid, non-null value for MEDICAID-COV-INPATIENT-DAYS, then the sum of CLAIM-HEADER-RECORD-IP.NON-COV-DAYS and CLAIM-HEADER-RECORD-IP.MEDICAID-COV-INPATIENT-DAYS is less than or equal to the number of days between the earliest CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE date and the latest CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE date plus one day', where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS does not equal '585'
05/18/2018	2.2.0	RULE-1011	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for NON-COV-DAYS and CLAIM-HEADER-RECORD-LT has a valid, non-null value for MEDICAID-COV-INPATIENT-DAYS and CLAIM-HEADER-RECORD-LT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT has a valid, non-null value for ENDING-DATE-OF-SERVICE, then the sum of CLAIM-HEADER-RECORD-LT.NON-COV-DAYS and CLAIM-HEADER-RECORD-LT.MEDICAID-COV-INPATIENT-DAYS is less than or equal to the number of days between CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for NON-COV-DAYS and CLAIM-HEADER-RECORD-LT has a valid, non-null value for MEDICAID-COV-INPATIENT-DAYS and CLAIM-HEADER-RECORD-LT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT has a valid, non-null value for ENDING-DATE-OF-SERVICE, then the sum of CLAIM-HEADER-RECORD-LT.NON-COV-DAYS and CLAIM-HEADER-RECORD-LT.MEDICAID-COV-INPATIENT-DAYS is less than or equal to the number of days between CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE, plus one day'
06/19/2020	2.4.0	RULE-426	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-FLAG-2, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-2'	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-2, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-2'
11/13/2020	2.4.0	Rule-7325	ADD	Data Dictionary - Validation Rules	N/A	For every record of type CLAIM-HEADER-RECORD-RX, ICN-ORIG must have a non-null value'
11/13/2020	2.4.0	Rule-7326	ADD	Data Dictionary - Validation Rules	N/A	For every record of type CLAIM-HEADER-RECORD-OT, ICN-ORIG must have a non-null value'
11/13/2020	2.4.0	Rule-7327	ADD	Data Dictionary - Validation Rules	N/A	For every record of type CLAIM-HEADER-RECORD-LT, ICN-ORIG must have a non-null value'
11/13/2020	2.4.0	Rule-7328	ADD	Data Dictionary - Validation Rules	N/A	For every record of type CLAIM-HEADER-RECORD-IP, ICN-ORIG must have a non-null value'
11/13/2020	2.4.0	Rule-7329	ADD	Data Dictionary - Validation Rules	N/A	For every record of type CLAIM-LINE-RECORD-RX, ICN-ORIG must have a non-null value'
11/13/2020	2.4.0	Rule-7330	ADD	Data Dictionary - Validation Rules	N/A	For every record of type CLAIM-LINE-RECORD-OT, ICN-ORIG must have a non-null value'
11/13/2020	2.4.0	Rule-7331	ADD	Data Dictionary - Validation Rules	N/A	For every record of type CLAIM-LINE-RECORD-LT, ICN-ORIG must have a non-null value'
11/13/2020	2.4.0	Rule-7332	ADD	Data Dictionary - Validation Rules	N/A	For every record of type CLAIM-LINE-RECORD-IP, ICN-ORIG must have a non-null value'
08/21/2020	2.4.0	RULE-7333	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '5', '6' then CLAIM-HEADER-RECORD-IP has a null value for ICN-ADJ'
08/21/2020	2.4.0	RULE-7334	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '5', '6' then CLAIM-HEADER-RECORD-LT has a null value for ICN-ADJ'
08/21/2020	2.4.0	RULE-7336	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '5', '6' then CLAIM-HEADER-RECORD-OT has a null value for ICN-ADJ'
08/21/2020	2.4.0	RULE-7335	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '5', '6' then CLAIM-HEADER-RECORD-RX has a null value for ICN-ADJ'
08/21/2020	2.4.0	RULE-7337	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-IP has a null value for ICN-ADJ then CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '5', '6''
08/21/2020	2.4.0	RULE-7338	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-LT has a null value for ICN-ADJ then CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '5', '6''
08/21/2020	2.4.0	RULE-7339	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-OT has a null value for ICN-ADJ then CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '5', '6''
08/21/2020	2.4.0	RULE-7340	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-RX has a null value for ICN-ADJ then CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '5', '6''
07/10/2020	2.4.0	AFFILIATED-PROGRAM-TYPE (PRV119)	UPDATE	Data Dictionary - Valid Values	\|Data Element Name\|Valid Value\|Description\|Effective Date\|End Date\| \|AFFILIATED-PROGRAM-TYPE\|1\|Health Plan (NHP-ID) – The value in the AFFILIATED-PROGRAM-ID data element contains the National Health Plan Identifier of health plan in which the provider is enrolled to provide services including through the state plan and a waiver.\|01/01/0001\|12/31/9999\|	N/A
08/21/2020	2.4.0	RULE-7341	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '4', '1' then CLAIM-HEADER-RECORD-IP has a non-null value for ICN-ADJ'
08/21/2020	2.4.0	RULE-7342	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '4', '1' then CLAIM-HEADER-RECORD-LT has a non-null value for ICN-ADJ'
08/21/2020	2.4.0	RULE-7343	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '4', '1' then CLAIM-HEADER-RECORD-OT has a non-null value for ICN-ADJ'
08/21/2020	2.4.0	RULE-7344	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '4', '1' then CLAIM-HEADER-RECORD-RX has a non-null value for ICN-ADJ'
08/21/2020	2.4.0	RULE-7345	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-IP has a non-null value for ICN-ADJ then CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '4', '1'
08/21/2020	2.4.0	RULE-7346	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-LT has a non-null value for ICN-ADJ then CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '4', '1'
08/21/2020	2.4.0	RULE-7347	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-OT has a non-null value for ICN-ADJ then CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '4', '1'
08/21/2020	2.4.0	RULE-7348	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-RX has a non-null value for ICN-ADJ then CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '4', '1'
09/11/2020	2.4.0	CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CIP 269, CLT 219, COT 210, CRX 149)	UPDATE	Data Dictionary - Valid Values	\|Code\|Description\|Effective Date\|End Date\| \|03\|Federal funding under ACA\|00010101\|99991231\|	\|Code\|Description\|Effective Date\|End Date\| \|03\|Federal funding under ACA\|00010101\|20200430\|
06/24/2022	3.0.0	CRX141/ DISPENSE-FEE-SUBMITTED	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CRX141\|DISPENSE-FEE	DE No\|Data Element Name CRX141\|DISPENSE-FEE-SUBMITTED
06/24/2022	3.0.0	CRX162/ PRESCRIPTION-ORIGIN-CODE	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX162\|PRESCRIPTION-ORIGIN-CODE\|X(1)\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002
09/11/2020	2.4.0	PROV-CLASSIFICATION-CODE	UPDATE	Data Dictionary - Valid Values	\|Code\|Current DDv2.3 definition\| \|62\|Psychologist, Clinical\| \|68\|Psychologist, Clinical\|	\|Code\|definition\| \|62\|Psychologist (Billing Independently)\| \|68\|Clinical Psychologist\|
09/11/2020	2.4.0	MANAGED-CARE-PLAN-TYPE	ADD	Data Dictionary - Valid Values	N/A	\|Code\|Description\| \|19\|Individual is enrolled in Long-Term Services & Supports (LTSS) and Mental Health (MH) PIHP\| \|20\|Other\|
09/11/2020	2.4.0	MANAGED-CARE-PLAN-TYPE	ADD	Data Dictionary - Valid Values	N/A	\|Code\|Description\|Effective Date\|End Date\| \|19\|Individual is enrolled in Long-Term Services & Supports (LTSS) and Mental Health (MH) PIHP\|00010101\|99991231\|
09/11/2020	2.4.0	CIP254, CLT208, COT178, CRX125	UPDATE	Data Dictionary	Current Coding Requirement: For claims where Medicaid payment is only available at the header level, report the entire payment amount on the MSIS record corresponding to the line item with the highest charge. Zero fill Medicaid Amount Paid on all other MSIS records created from the original claim.	Proposed Coding requirement: For claims where Medicaid payment is only available at the header level, report the entire payment amount on the MSIS record corresponding to the line item with the highest charge or the 1st detail. Zero fill Medicaid Amount Paid on all other MSIS records created from the original claim.
09/11/2020	2.4.0	RULE-2143	UPDATE	Data Dictionary - Validation Rules	if ELIGIBILITY-DETERMINANTS.SSI-STATUS equals '003' or ELIGIBILITY-DETERMINANTS has a null or invalid value for SSI-STATUS, then ELIGIBILITY-DETERMINANTS.SSI-IND equals '0'	if ELIGIBILITY-DETERMINANTS.SSI-STATUS equals ‘003' or '000’ or ELIGIBILITY-DETERMINANTS has a null or invalid value for SSI-STATUS, then ELIGIBILITY-DETERMINANTS.SSI-IND equals '0'
11/13/2020	2.4.0	Rule-7297	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '139', '140', '141','142' and For every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE then ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is not equal to null or '00'
09/11/2020	2.4.0	RULE-7204	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not in ('Z','3','C','W') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1' then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'
09/11/2020	2.4.0	RULE-7205	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.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'	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.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM not in ('Z','3','C','W') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'
09/11/2020	2.4.0	RULE-7206	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM not in ('Z','3','C','W') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'
09/11/2020	2.4.0	RULE-7207	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', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'	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', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM not in ('Z','3','C','W') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'
09/11/2020	2.4.0	RULE-824	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.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'	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.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM not in ('Z','3','C','W') and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'
09/11/2020	2.4.0	RULE-1256	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', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'	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', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM not in ('Z','3','C','W') and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'
09/11/2020	2.4.0	RULE-1691	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not in ('Z','3','C','W') and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'
09/11/2020	2.4.0	RULE-1955	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF- CLAIM not in ('Z','3','C','W') and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02
09/11/2020	2.4.0	RULE-7372	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.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
09/11/2020	2.4.0	RULE-7373	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
09/11/2020	2.4.0	RULE-7374	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
09/11/2020	2.4.0	RULE-7375	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0" or "4" and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
09/11/2020	2.4.0	RULE-7376	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.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
09/11/2020	2.4.0	RULE-7377	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
09/11/2020	2.4.0	RULE-7378	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
09/11/2020	2.4.0	RULE-7379	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
09/11/2020	2.4.0	RULE-7380	ADD	Data Dictionary - Validation Rules	N/A	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MSIS-IDENTIFICATION-NUM has a non-null value then VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for CITIZENSHIP-IND'
09/11/2020	2.4.0	RULE-7381	ADD	Data Dictionary - Validation Rules	N/A	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MSIS-IDENTIFICATION-NUM has a non-null value then VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for IMMIGRATION-STATUS'
10/02/2020	2.4.0	LINE-NUM-ADJ LINE-ADJUSTMENT-IND	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Coding Requirement\|CR No\| \|CIP238\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0. Otherwise, if there is a line adjustment indicator, then there should be a line adjustment number. \|Not Applicable\| \|CIP239\|LINE-ADJUSTMENT-IND\|If there is a line adjustment number, then there must be a line-adjustment indicator.\|CIP239-0002\| \|CLT191\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0. Otherwise, if there is a line adjustment indicator, then there should be a line adjustment number.\|CLT191-0002\| \|CLT192\|LINE-ADJUSTMENT-IND\|If there is a line adjustment number, then there must be a line-adjustment indicator.\|CLT192-0002\| \|CLT192\|LINE-ADJUSTMENT-IND\|If there is a line adjustment reason, then there must be a line adjustment indicator.\|CLT192-0003 \|COT161\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0. Otherwise, if there is a line adjustment indicator, then there should be a line adjustment number.\|COT161-0002\| \|COT162\|LINE-ADJUSTMENT-IND\|If there is a line adjustment number, then there must be a line-adjustment indicator.\|COT162-0002\| \|COT162\|LINE-ADJUSTMENT-IND\|If there is a line adjustment reason, then there must be a line adjustment indicator.\|COT162-003\| \|CRX115\|LINE-NUM-ADJ\|This field should be 8-filled, left blank or space-filled if the ADJUSTMENT-INDICATOR = 0. Otherwise, if there is a line adjustment indicator, then there should be a line adjustment number.\|CRX115-002\| \|CRX116\|LINE-ADJUSTMENT-IND\|If there is a line adjustment number, then there must be a line-adjustment indicator.\|CRX116-002\|	\|DE No\|Data Element Name\|Coding Requirement\|CR No\| \|CIP238\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0.\|Not Applicable\| \|CIP239\|LINE-ADJUSTMENT-IND\|Not Applicable.\|CIP239-0002\| \|CLT191\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0.\|CLT191-0002\| \|CLT192\|LINE-ADJUSTMENT-IND\|Not Applicable.\|CLT192-0002\| \|CLT192\|LINE-ADJUSTMENT-IND\|Not Applicable.\|CLT192-0003 \|COT161\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0.\|COT161-0002\| \|COT162\|LINE-ADJUSTMENT-IND\|Not Applicable.\|COT162-0002\| \|COT162\|LINE-ADJUSTMENT-IND\|Not Applicable.\|COT162-003\| \|CRX115\|LINE-NUM-ADJ\|This field should be 8-filled, left blank or space-filled if the ADJUSTMENT-INDICATOR = 0.\|CRX115-002\| \|CRX116\|LINE-ADJUSTMENT-IND\|Not Applicable.\|CRX116-002\|
09/11/2020	2.4.0	PROV-CLASSIFICATION-CODE	UPDATE	Data Dictionary - Valid Values	\|Code\|Definition\| \|62\|Psychologist, Clinical\| \|68\|Psychologist, Clinical\|	\|Code\|Definition\| \|62\|Psychologist (Billing Independently)\| \|68\|Clinical Psychologist\|
09/11/2020	2.4.0	RULE-7382	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', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE'
09/11/2020	2.4.0	RULE-7383	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', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for DISCHARGE-DATE'
09/11/2020	2.4.0	RULE-7394	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.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
09/11/2020	2.4.0	RULE-7392	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26' '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
09/11/2020	2.4.0	RULE-7393	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
09/11/2020	2.4.0	RULE-7395	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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
09/11/2020	2.4.0	RULE-7396	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
09/11/2020	2.4.0	RULE-7397	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
09/11/2020	2.4.0	RULE-7398	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.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
09/11/2020	2.4.0	RULE-7399	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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
09/11/2020	2.4.0	RULE-7404	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.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-LT has a non-null value for SERVICE-TRACKING-TYPE'
09/11/2020	2.4.0	RULE-7405	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-OT has a non-null value for SERVICE-TRACKING-TYPE'
09/11/2020	2.4.0	RULE-7406	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-RX has a non-null value for SERVICE-TRACKING-TYPE'
09/11/2020	2.4.0	RULE-7400	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', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT'
09/11/2020	2.4.0	RULE-7401	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.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT'
09/11/2020	2.4.0	RULE-7402	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT'
09/11/2020	2.4.0	RULE-7403	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT'
09/11/2020	2.4.0	RULE-7384	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', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
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'
09/11/2020	2.4.0	RULE-7387	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
09/11/2020	2.4.0	RULE-7388	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
09/11/2020	2.4.0	RULE-7385	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', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to 'D' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
09/11/2020	2.4.0	RULE-7389	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 'D' 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 XXI-MBESCBES-CATEGORY-OF-SERVICE'
09/11/2020	2.4.0	RULE-7390	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'D' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
09/11/2020	2.4.0	RULE-7391	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to 'D' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
10/02/2020	2.4.0	Rule-7423	ADD	Data Dictionary - Validation Rules	N/A	'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE has non-null and not invalidly formatted value and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null and not invalidly formatted value for DATE-OF-BIRTH then ((if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has non-null and not invalidly formatted value for DATE-OF-DEATH then the difference between dates PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-BIRTH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH is between -1 and 120 years) or (if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has null value for DATE-OF-DEATH then the difference between dates PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-BIRTH and FILE-HEADER-RECORD-ELIGIBILITY.START-OF-TIME-PERIOD is between -1 and 120 years))
10/02/2020	2.4.0	RULE-775	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for LINE-NUM-ADJ and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP has a valid, non-null value for LINE-ADJUSTMENT-IND'	N/A
10/02/2020	2.4.0	RULE-1917	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for LINE-NUM-ADJ and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX has a valid, non-null value for LINE-ADJUSTMENT-IND'	N/A
10/02/2020	2.4.0	RULE-1617	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for LINE-NUM-ADJ and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT has a valid, non-null value for LINE-ADJUSTMENT-IND'	N/A
10/02/2020	2.4.0	RULE-1212	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for LINE-NUM-ADJ and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT has a valid, non-null value for LINE-ADJUSTMENT-IND'	N/A
10/02/2020	2.4.0	Rule-7412	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 to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM not equal to "Z" AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN ("1", "3") AND CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR is equal to "1" AND CLAIM-HEADER-RECORD-IP has a non-null value for MSIS-IDENTIFICATION-NUM' AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE has non-null and not invalidly formatted value and ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE has non-null and not invalidly formatted value and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE AND ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to "1" THEN ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01','02','03','04','05','06','08','09','10'
10/02/2020	2.4.0	Rule-7413	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 to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM not equal to "Z" AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN ("1", "3") AND CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR is equal to "1" AND CLAIM-HEADER-RECORD-LT has a non-null value for MSIS-IDENTIFICATION-NUM' AND CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE has non-null and not invalidly formatted value and ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE has non-null and not invalidly formatted value and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE AND ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to "1" THEN ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01','02','03','04','05','06','08','09','10'
10/02/2020	2.4.0	Rule-7414	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM not equal to "Z" AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN ("1", "3") AND CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR is equal to "1" AND CLAIM-HEADER-RECORD-RX has a non-null value for MSIS-IDENTIFICATION-NUM' AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non-null and not invalidly formatted value and ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE has non-null and not invalidly formatted value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE AND ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to "1" THEN ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01','02','03','04','05','06','08','09','10'
10/02/2020	2.4.0	Rule-7424	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to "Z" AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN ("1", "3") AND CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR is equal to "1" AND CLAIM-HEADER-RECORD-OT has a non-null value for MSIS-IDENTIFICATION-NUM' AND CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE has non-null and not invalidly formatted value and ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE has non-null and not invalidly formatted value and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE AND ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to "1" THEN ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01','02','03','04','05','06','08','09','10'
10/02/2020	2.4.0	Rule-7419	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE AND ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' AND ELIGIBILITY-DETERMINANTS.ELIGIBLE-GROUP is equal to one of the following: '23', '24', '25' ,'26' THEN then ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01','02','03','04','05', '06', '08','09', '10' O10
10/02/2020	2.4.0	Rule-7420	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE AND ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to '3' AND ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' then ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01','03','05', '06'
10/02/2020	2.4.0	Rule-7421	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE AND ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01','03','05', '06' AND ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' then ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to '3'
11/13/2020	2.4.0	ELG156-0003	UPDATE	Data Dictionary	If a complete, valid end date is not available or is unknown, leave blank, or space-fill".	N/A
10/02/2020	2.4.0	Rule-7370	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM then ELIGIBILITY-DETERMINANTS has a non-null value for RESTRICTED-BENEFITS-CODE
10/02/2020	2.4.0	Rule-7371	ADD	Data Dictionary - Validation Rules	N/A	If ENROLLMENT-TIME-SPAN has a non-null value for MSIS-IDENTIFICATION-NUM then ENROLLMENT-TIME-SPAN has a non-null value for ENROLLMENT-TYPE
10/02/2020	2.4.0	Rule-7407	ADD	Data Dictionary - Validation Rules	N/A	if MANAGED-CARE-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-TYPE is equal to one of the following: '01', '02', '03', '04', '05', '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', 20', '60', '70', '80' then MANAGED-CARE-PARTICIPATION has a non-null value for MANAGED-CARE-PLAN-ID
10/02/2020	2.4.0	Rule-7408	ADD	Data Dictionary - Validation Rules	N/A	if MANAGED-CARE-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION has a non-null value for MANAGED-CARE-PLAN-ID then MANAGED-CARE-PARTICIPATION has a non-null value for MANAGED-CARE-PLAN-TYPE
10/02/2020	2.4.0	Rule-7411	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to '6' then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP is equal to one of the following: ' 35', '70'.
06/24/2022	3.0.0	CIP290/ BEGINNING-DATE-OF-SERVICE	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP290\|BEGINNING-DATE-OF-SERVICE\|9(8)\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002
06/24/2022	3.0.0	CIP291	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CIP291\|ENDING-DATE-OF-SERVICE\|Mandatory\|For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, the date on which the service covered by this claim ended. For capitation premium payments, the date on which the period of coverage related to this payment ends/ended. For financial transactions reported to the OT file, populate with the last day of the time period covered by this financial transaction.\|Value must be 8 characters in the form "CCYYMMDD" The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st) When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated End of Time Period value Value must be greater than or equal to associated Beginning Date of Service value When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated Adjudication Date value Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated Value must be equal to or greater than associated Date of Birth (ELG.002.024) value\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002
06/24/2022	3.0.0	CIP291/ ENDING-DATE-OF-SERVICE	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP291\| ENDING-DATE-OF-SERVICE\|9(8)\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002
12/04/2020	2.4.0	RULE-7443	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 '0' or '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NUM then For every record of type CLAIM-LINE-RECORD-IP, (there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys (CLAIM-LINE-RECORD-IP.SUBMITTING-STATE, CLAIM-LINE-RECORD-IP.SERVICING-PROV-NUM with PROV-MEDICAID-ENROLLMENT.SUBMITTING-STATE, PROV-MEDICAID-ENROLLMENT. SUBMITTING-STATE-PROV-ID) where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' and (CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is greater than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE))
12/04/2020	2.4.0	RULE-7444	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' 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 has a non-null value for SERVICING-PROV-NUM then For every record of type CLAIM-LINE-RECORD-LT, (there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys (CLAIM-LINE-RECORD-LT.SUBMITTING-STATE, CLAIM-LINE-RECORD-LT.SERVICING-PROV-NUM with PROV-MEDICAID-ENROLLMENT.SUBMITTING-STATE, PROV-MEDICAID-ENROLLMENT. SUBMITTING-STATE-PROV-ID) where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' and (CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE is greater than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE is less than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE))
12/04/2020	2.4.0	RULE-7445	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NUM then For every record of type CLAIM-LINE-RECORD-OT, (there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys (CLAIM-LINE-RECORD-OT.SUBMITTING-STATE, CLAIM-LINE-RECORD-OT.SERVICING-PROV-NUM with PROV-MEDICAID-ENROLLMENT.SUBMITTING-STATE, PROV-MEDICAID-ENROLLMENT. SUBMITTING-STATE-PROV-ID) where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' and (CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is greater than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE))
12/04/2020	2.4.0	RULE-7446	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM then For every record of type CLAIM-HEADER-RECORD-RX, (there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE, CLAIM-HEADER-RECORD-RX.DISPENSING-PRESCRIPTION-DRUG-PROV-NUM with PROV-MEDICAID-ENROLLMENT.SUBMITTING-STATE, PROV-MEDICAID-ENROLLMENT. SUBMITTING-STATE-PROV-ID) where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' and (CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is greater than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is less than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE))
07/02/2021	3.0.0	RULE-7427	ADD	Data Dictionary - Validation Rules	N/A	if WAIVER-PARTICIPATION.WAIVER-TYPE is equal to '24', then for every record of type WAIVER-PARTICIPATION, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM), and (WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE >= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE <= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE), and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to '6'
07/02/2021	3.0.0	RULE-7428	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to 'C', and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) and (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE), and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '3'
07/02/2021	3.0.0	RULE-7429	ADD	Data Dictionary - Validation Rules	N/A	if MFP-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM then for every record of type MFP-INFORMATION, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) and (MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and MFP-INFORMATION.MFP-ENROLLMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE), and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to 'D'
07/02/2021	3.0.0	RULE-7430	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to 'D' and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type MFP-INFORMATION that matches on the join keys (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE >= MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE)
11/13/2020	2.4.0	Rule-7351	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL and CLAIM-HEADER-RECORD-OT has a non-null value for PLACE-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to the following: '1', '3', 'A', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL or CLAIM-HEADER-RECORD-OT has a non-null value for PLACE-OF-SERVICE'
11/13/2020	2.4.0	Rule-7354	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE and CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and TYPE-OF-CLAIM is equal to the following: '1', '3', 'A', 'C' then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE or CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE'
11/13/2020	2.4.0	Rule-7384	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', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'	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', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-IP has a non-null value for XXI-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'
11/13/2020	2.4.0	Rule-7387	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
11/13/2020	2.4.0	Rule-7388	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal '4' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal '4' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
11/13/2020	2.4.0	Rule-7372	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.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'	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.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
11/13/2020	2.4.0	Rule-7373	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' 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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' 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'
11/13/2020	2.4.0	Rule-7374	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
11/13/2020	2.4.0	Rule-7375	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
11/13/2020	2.4.0	PROCEDURE-CODE-MOD	UPDATE	Data Dictionary - Valid Values	\|Valid Value\|Effective Date\|End Date\|Value\|Name\|Description\| \|PROCEDURE-CODE-MOD\|20170101\|99991231\|PO\|Excepted off-campus service\|Excepted service provided at an off-campus, outpatient, provider-based department of a hospital\|	\|Valid Value\|Effective Date\|End Date\|Value\|Name\|Description\| \|PROCEDURE-CODE-MOD\|20150101\|99991231\|PO\|Excepted off-campus service\|Excepted service provided at an off-campus, outpatient, provider-based department of a hospital\|
10/02/2020	2.4.0	CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CIP 269, CLT 219, COT 210, CRX 149)	UPDATE	Data Dictionary - Valid Values	\|Code\|Description\|Effective Date\|End Date\| \|03\|Federal funding under ACA\|00010101\|20200430\|	\|Code\|Description\|Effective Date\|End Date\| \|03\|Federal funding under ACA\|00010101\|20200930\|
11/13/2020	2.4.0	NEW-REFILL-IND	UPDATE	Data Dictionary - Valid Values	N/A	\|Valid Value\|Effective Date\| End Date\|Code\|Description\| \|NEW-REFILL-IND\|00010101\|99991231\|99\|Number of Refill(s)\|
12/04/2020	2.4.0	TYPE-OF-SERVICE	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|TYPE-OF-SERVICE\| 20201001\|99991231\|145\|Medication Assisted Treatment (MAT) services and drugs for evidenced-based treatment of Opioid Use Disorder (OUD) in accordance with section 1905(a)(29) of the Social Security Act\|Effective October 1, 2020, state Medicaid programs are required to provide coverage of Medication Assisted Treatment (MAT) services and drugs under a new mandatory benefit. The SUPPORT Act of 2018 (P.L. 115-271) amended the Social Security Act (the Act) to add this new mandatory benefit. The purpose of the new mandatory MAT benefit found at section 1905(a)(29) of the Act is to increase access to evidenced-based treatment for Opioid Use Disorder (OUD) for all Medicaid beneficiaries and to allow patients to seek the best course of treatment and particular medications that may not have been previously covered. CMS interprets sections 1905(a)(29) and 1905(ee) of the Act to require that, as of October 1, 2020, states must include as part of the new MAT mandatory benefit all forms of drugs and biologicals that the Food and Drug Administration (FDA) has approved or licensed for MAT to treat OUD. More specifically, under the new mandatory MAT benefit, states are required to cover such FDA approved or licensed drugs and biologicals used for indications for MAT to treat OUD. States currently cover many of these MAT drugs and biologicals (for all medically-accepted indications) under the optional benefit for prescribed drugs described at section 1905(a)(12) of the Act.\| TYPE-OF-SERVICE value ‘145’ is applicable to the T-MSIS OT and RX files. Section 1905(a)(29) of the Social Security Act stipulates that the benefit applies to the period of October 1, 2020 through September 30, 2025, however states may continue to adjudicate and submit claims to T-MSIS for this type of service beyond September 30, 2025 for dates of service prior to September 30, 2025. This value may be end-dated at some point in the future after it is clear that there will be no more claims submitted to T-MSIS with it. State T-MSIS team members are encouraged to reach out to their state policy experts to determine how this type of service has been incorporated into the state’s Medicaid program.
11/13/2020	2.4.0	RULE-1423	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-OT.BILLING-PROV-NUM'	N/A
11/13/2020	2.4.0	RULE-7431	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 is not equal to 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-HEADER-RECORD-IP has corresponding child record CLAIM-LINE-RECORD-IP
11/13/2020	2.4.0	RULE-7432	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 is not equal to 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-HEADER-RECORD-LT has corresponding child record CLAIM-LINE-RECORD-LT
11/13/2020	2.4.0	RULE-7433	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-HEADER-RECORD-OT has corresponding child record CLAIM-LINE-RECORD-OT
11/13/2020	2.4.0	RULE-7434	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-HEADER-RECORD-RX has corresponding child record CLAIM-LINE-RECORD-RX
11/13/2020	2.4.0	RULE-7439	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 '0' or '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NUM then For every record of type CLAIM-HEADER-RECORD-IP, (there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys (CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE, CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM with PROV-MEDICAID-ENROLLMENT.SUBMITTING-STATE, PROV-MEDICAID-ENROLLMENT. SUBMITTING-STATE-PROV-ID) where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '40', '05', '06' and (CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is greater than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is less than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE))
11/13/2020	2.4.0	RULE-7440	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NUM then For every record of type CLAIM-HEADER-RECORD-LT (there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM with PROV-MEDICAID-ENROLLMENT.SUBMITTING-STATE, PROV-MEDICAID-ENROLLMENT. SUBMITTING-STATE-PROV-ID) where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '40', '05', '06' and (CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE is greater than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE is less than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE))
11/13/2020	2.4.0	RULE-7441	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM then For every record of type CLAIM-HEADER-RECORD-OT, (there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys (CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-OT.BILLING-PROV-NUM with PROV-MEDICAID-ENROLLMENT.SUBMITTING-STATE, PROV-MEDICAID-ENROLLMENT. SUBMITTING-STATE-PROV-ID) where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '40', '05', '06' and (CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE is greater than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE))
11/13/2020	2.4.0	RULE-7442	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NUM then For every record of type CLAIM-HEADER-RECORD-RX, (there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE, CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-MEDICAID-ENROLLMENT.SUBMITTING-STATE, PROV-MEDICAID-ENROLLMENT. SUBMITTING-STATE-PROV-ID) where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '40', '05', '06' and (CLAIM-HEADER-RECORD-RX. PRESCRIPTION-FILL-DATE is greater than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is less than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE))
11/13/2020	2.4.0	RULE-7435	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 '0' or '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICAID-PAID-AMT'
11/13/2020	2.4.0	RULE-7436	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICAID-PAID-AMT'
11/13/2020	2.4.0	RULE-7437	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICAID-PAID-AMT'
11/13/2020	2.4.0	RULE-7438	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICAID-PAID-AMT'
12/04/2020	2.4.0	RULE-7448	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 '0' or '4' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR is equal to '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' then (CLAIM-HEADER-RECORD-IP has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT is equal to 0.00) and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT is equal to 0.00) and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT is equal to 0.00)
12/04/2020	2.4.0	RULE-7449	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR is equal to '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' then (CLAIM-HEADER-RECORD-LT has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT is equal to 0.00) and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is equal to 0.00) and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT is equal to 0.00)
12/04/2020	2.4.0	RULE-7450	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR is equal to '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' and for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type CLAIM-LINE-RECORD-OT that matches on the join keys and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' then (CLAIM-HEADER-RECORD-OT has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-OT.MEDICARE-PAID-AMT is equal to 0.00) and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT is equal to 0.00) and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT is equal to 0.00)
12/04/2020	2.4.0	RULE-7451	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR is equal to '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' and for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type CLAIM-LINE-RECORD-RX that matches on the join keys and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' then (CLAIM-HEADER-RECORD-RX has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-RX.MEDICARE-PAID-AMT is equal to 0.00) and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT is equal to 0.00) and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT is equal to 0.00)
12/04/2020	2.4.0	RULE-7452	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 '0' or '4' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR is equal to '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' then (CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT)
12/04/2020	2.4.0	RULE-7453	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR is equal to '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' then (CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT)
12/04/2020	2.4.0	RULE-7454	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR is equal to '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' and for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type CLAIM-LINE-RECORD-OT that matches on the join keys and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' then (CLAIM-LINE-RECORD-OT has a non-null value and not invalidly formatted value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT)
12/04/2020	2.4.0	RULE-7455	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR is equal to '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' and for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type CLAIM-LINE-RECORD-RX that matches on the join keys and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' then (CLAIM-LINE-RECORD-RX has a non-null value and not invalidly formatted value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT)
07/23/2021	3.0.0	RULE-7409	UPDATE	Data Dictionary - Validation Rules	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE has non-null and not invalidly formatted value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '2' then ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '07','31','61	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '2' then For every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM) and (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)) and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '07','31','61' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01'
07/23/2021	3.0.0	RULE-7410	UPDATE	Data Dictionary - Validation Rules	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE has non-null and not invalidly formatted value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '3' then ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '61','62','63','64','65','66','67','68'.	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '3' then For every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM) and (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)) and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '61','62','63','64','65','66','67','68' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01'
07/23/2021	3.0.0	RULE-7422	UPDATE	Data Dictionary - Validation Rules	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE has non-null and not invalidly formatted value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1' then ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '61','62','63','64','65','66','67','68'.	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1' then For every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM) and (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)) and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is not equal to one of the following: '61','62','63','64','65','66','67','68' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01'
12/04/2020	2.4.0	HCPCS-RATE (COT220)	UPDATE	Data Dictionary	\|Definition\|Necessity\|Coding Requirement\| \|For outpatient hospital facility claims, HCPCS/CPT is captured here. This data element is expected to capture data from HIPAA 837I claim loop 2400 SV202 or UB-04 FL 44 (only if the value represents a HCPCS/CPT). If HCPCS-RATE is populated then PROCEDURE-CODE should not be populated.\|Conditional\|Value must be equal to a valid value.\|	\|Definition\|Necessity\|Coding Requirement\| \|Not to be populated\|Not Applicable\|Do not populate\|
12/04/2020	2.4.0	RULE-423	UPDATE	Data Dictionary - Validation Rules	'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' and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-1, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-1'	N/A
12/04/2020	2.4.0	RULE-436	UPDATE	Data Dictionary - Validation Rules	'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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-2 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-2'	N/A
12/04/2020	2.4.0	RULE-449	UPDATE	Data Dictionary - Validation Rules	'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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-3 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-3'	N/A
12/04/2020	2.4.0	RULE-463	UPDATE	Data Dictionary - Validation Rules	'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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-4 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-4'	N/A
12/04/2020	2.4.0	RULE-476	UPDATE	Data Dictionary - Validation Rules	'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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-5 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-5'	N/A
12/04/2020	2.4.0	RULE-488	UPDATE	Data Dictionary - Validation Rules	'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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-6 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-6'	N/A
01/27/2021	3.0.0	RULE-532	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X', then CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT equals '0.00''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X', then (CLAIM-HEADER-RECORD-IP has a null value for TOT-BILLED-AMT or CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT is equal to 0.00)'
01/27/2021	3.0.0	RULE-545	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.MEDICARE-COMB-DED-IND equals '1', then CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT equals '0.00''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.MEDICARE-COMB-DED-IND equals '1', then (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT is equal to 0.00)
01/27/2021	3.0.0	RULE-710	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.OUTLIER-CODE is equal to one of the following: '00', '09', then CLAIM-HEADER-RECORD-IP has a null or invalid value for DRG-OUTLIER-AMT or CLAIM-HEADER-RECORD-IP.DRG-OUTLIER-AMT equals '0.00''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.OUTLIER-CODE is equal to one of the following: '00', '09', then (CLAIM-HEADER-RECORD-IP has a null value for DRG-OUTLIER-AMT or CLAIM-HEADER-RECORD-IP.DRG-OUTLIER-AMT is equal to 0.00)
01/27/2021	3.0.0	RULE-984	UPDATE	Data Dictionary - Validation Rules	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.TOT-MEDICARE-COINS-AMT equals '0.00''	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 is equal to 0.00)
01/27/2021	3.0.0	RULE-1403	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.MEDICARE-COMB-DED-IND equals '1', then CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT equals '0.00''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.MEDICARE-COMB-DED-IND equals '1', then (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT is equal to 0.00)
01/27/2021	3.0.0	RULE-1788	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X', then CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT equals '0.00''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X', then (CLAIM-HEADER-RECORD-RX has a null value for TOT-BILLED-AMT or CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT is equal to 0.00)
01/27/2021	3.0.0	RULE-1801	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.MEDICARE-COMB-DED-IND equals '1', then CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT equals '0.00''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.MEDICARE-COMB-DED-IND equals '1', then (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT is equal to 0.00)
12/04/2020	2.4.0	TOT-BILLED-AMT	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \|CODING REQUIREMENT\| \|CIP112 \|TOT-BILLED-AMT\| Not Applicable \|Not Applicable \|If TYPE-OF-CLAIM = "4", then TOT-BILLED-AMT must = "00000000".\| \|CLT063 \|TOT-BILLED-AMT\| Not Applicable \|Not Applicable \|If TYPE-OF-CLAIM = "4", then TOT-BILLED-AMT must = "00000000".\| \|COT048 \|TOT-BILLED-AMT\| Not Applicable \|Not Applicable \|If TYPE-OF-CLAIM = "4", then TOT-BILLED-AMT must = "00000000".\| \|CRX039 \|TOT-BILLED-AMT\| Not Applicable \|Not Applicable \|If TYPE-OF-CLAIM = "4", then TOT-BILLED-AMT must = "00000000".\|	N/A
12/04/2020	2.4.0	RULE-7447	ADD	Data Dictionary - Validation Rules	N/A	‘if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1', then ELIGIBILITY-DETERMINANTS has a non-null value for ELIGIBILITY-GROUP’
01/27/2021	3.0.0	RULE-7372	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.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
01/27/2021	3.0.0	RULE-7373	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' 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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '5' 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 TOT-MEDICAID-PAID-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
01/27/2021	3.0.0	RULE-7374	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '2', '5' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
01/27/2021	3.0.0	RULE-7375	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
01/27/2021	3.0.0	RULE-7376	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.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02' then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
01/27/2021	3.0.0	RULE-7377	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then 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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E' 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 TOT-MEDICAID-PAID-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 '02' then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
01/27/2021	3.0.0	RULE-7378	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', 'B', 'E' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02' then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
01/27/2021	3.0.0	RULE-7379	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02' then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
12/04/2020	2.4.0	RULE-7372	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.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
12/04/2020	2.4.0	RULE-7373	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' 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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '5' 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 TOT-MEDICAID-PAID-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
12/04/2020	2.4.0	RULE-7374	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '2', '5' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
12/04/2020	2.4.0	RULE-7375	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
12/04/2020	2.4.0	RULE-7376	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.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02' then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
12/04/2020	2.4.0	RULE-7377	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then 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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E' 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 TOT-MEDICAID-PAID-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 '02' then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
12/04/2020	2.4.0	RULE-7378	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', 'B', 'E' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02' then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
12/04/2020	2.4.0	RULE-7379	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02' then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
01/27/2021	3.0.0	RULE-7384	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', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
01/27/2021	3.0.0	RULE-7385	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', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to 'D' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02' then CLAIM-LINE-RECORD-IP 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
01/27/2021	3.0.0	RULE-7387	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
01/27/2021	3.0.0	RULE-7388	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal '4' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
01/27/2021	3.0.0	RULE-7389	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 'D' 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 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 one of the following: '4', 'D' 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 '02' then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
01/27/2021	3.0.0	RULE-7390	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'D' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02' then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
01/27/2021	3.0.0	RULE-7391	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to 'D' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02' then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
12/04/2020	2.4.0	RULE-7384	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', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
12/04/2020	2.4.0	RULE-7385	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', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to 'D' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02' then CLAIM-LINE-RECORD-IP has a non-null value for XXI-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
12/04/2020	2.4.0	RULE-7387	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
12/04/2020	2.4.0	RULE-7388	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal '4' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
12/04/2020	2.4.0	RULE-7389	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 'D' 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 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 one of the following: '4', 'D' 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 '02' then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
12/04/2020	2.4.0	RULE-7390	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'D' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02' then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
12/04/2020	2.4.0	RULE-7391	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to 'D' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02' then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
12/04/2020	2.4.0	439-E4 (Reason For Service Code)	ADD	Data Dictionary - Valid Values	N/A	\|Valid Value\|Effective Date\|End Date\|Value\|Description\| \|Drug-Utilization-Code-E4\|00010101\|99991231\|TD\|Therapeutic - Code indication that a simultaneous use of different primary generic chemical entities that have the same therapeutic effect was detected.\| \|Drug-Utilization-Code-E4\|00010101\|99991231\|SR\|Suboptimal Regimen - Code indicating incorrect, inappropriate, or less than optimal dosage regimen specified for the drug in question.\|
12/04/2020	2.4.0	RULE-7435	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: '4', 'D', then CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICAID-PAID-AMT'	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: '4', 'D', then (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is equal to 0.00)
12/04/2020	2.4.0	RULE-7436	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICAID-PAID-AMT'	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is equal to 0.00)'
12/04/2020	2.4.0	RULE-7437	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICAID-PAID-AMT'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is equal to 0.00)'
12/04/2020	2.4.0	RULE-7438	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICAID-PAID-AMT'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is equal to 0.00)'
01/27/2021	3.0.0	RULE-1871	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PRESCRIPTION-FILL-DATE, then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' .'686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PRESCRIPTION-FILL-DATE, then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'
01/27/2021	3.0.0	RULE-7200	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)
01/27/2021	3.0.0	RULE-7196	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654','686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)
01/27/2021	3.0.0	RULE-1337	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654','686' then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys
01/27/2021	3.0.0	RULE-884	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 is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys	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 is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654','686' then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys
01/27/2021	3.0.0	RULE-1691	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654','686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654','686' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02''
01/27/2021	3.0.0	RULE-1955	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02''
01/27/2021	3.0.0	RULE-824	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.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02''	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.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02''
01/27/2021	3.0.0	RULE-7204	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' , '686' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01''
01/27/2021	3.0.0	RULE-7205	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.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01''	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.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01''
01/27/2021	3.0.0	RULE-7206	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01''
01/27/2021	3.0.0	RULE-519	UPDATE	Data Dictionary - Validation Rules	if ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '00' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE and 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 CLAIM-HEADER-RECORD-IP.ALLOWED-CHARGE-SRC is not equal to one of the following: '1', 'I', 'K', 'M''	if ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '00' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to CLAIM-HEADER-RECORD-IP.ADMISSION-DATE and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE and 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.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686’ then CLAIM-HEADER-RECORD-IP.ALLOWED-CHARGE-SRC is not equal to one of the following: '1', 'I', 'K', 'M'' then CLAIM-HEADER-RECORD-IP.ALLOWED-CHARGE-SRC is not equal to one of the following: '1', 'I', 'K', 'M''
03/19/2021	3.0.0	TYPE-OF-SERVICE	UPDATE	Data Dictionary - Valid Values	N/A	\|Data Element\|Effective Date\|End Date\|Value\|Name\| \|TYPE-OF-SERVICE\|00010101\|99991231\|146\|Inpatient Psychiatric Services for beneficiaries between the ages of 22 and 64 who receive services in an institution for mental disease (IMD)\|
06/24/2022	3.0.0	COT228/ ORDERING-PROV-NUM	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT228\|ORDERING-PROV-NUM\|X(30)\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002
06/24/2022	3.0.0	COT229/ ORDERING-PROV-NPI-NUM	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT229\|ORDERING-PROV-NPI-NUM\|X(10)\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002
12/04/2020	2.4.0	CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CIP269-0002, CLT219-0002, COT210-0002, CRX149-0002)	UPDATE	Data Dictionary	CIP269-0002 : If an individual is not eligible for S-CHIP, then any associated claims records should not have reimbursed with federal funding under Title XXI. CLT219-0002: If an individual is not eligible for S-CHIP, then any associated claims records should not have reimbursed with federal funding under Title XXI. COT210-0002: If an individual is not eligible for S-CHIP, then any associated claims records should not have reimbursed with federal funding under Title XXI. CRX149-0002: If an individual is not eligible for S-CHIP, then any associated claims records should not have reimbursed with federal funding under Title XXI.	CIP269: (federal Funding under Title XXI) if value equals ‘02’, then the eligible’s CHIP Code (ELG.003.054) must be in ['2', '3'] CLT219: (federal Funding under Title XXI) if value equals ‘02’, then the eligible’s CHIP Code (ELG.003.054) must be in ['2', '3'] COT210: (federal Funding under Title XXI) if value equals ‘02’, then the eligible’s CHIP Code (ELG.003.054) must be in ['2', '3'] CRX149: I(federal Funding under Title XXI) if value equals ‘02’, then the eligible’s CHIP Code (ELG.003.054) must be in ['2', '3']
12/04/2020	2.4.0	CIP177-0003, CLT128-0003, COT110-0003, and CRX068-0004	UPDATE	Data Dictionary	coding requirements say: "An ineligible individual cannot have a category for federal reimbursement for Medicaid or CHIP (CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT <> 01,02)"	N/A
02/05/2021	3.0.0	RULE-689	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 is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' 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 has a valid, non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-IP, ((there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and CLAIM-HEADER-RECORD-IP has a null value for DISCHARGE-DATE or CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE must be in (PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE, PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-IP has a null value for DISCHARGE-DATE or CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE must be in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-IP, ((there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and CLAIM-HEADER-RECORD-IP has a null value for DISCHARGE-DATE or CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE must be in (PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE, PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-IP has a null value for DISCHARGE-DATE or CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE must be in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))
02/05/2021	3.0.0	RULE-1126	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 is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' 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 has a valid, non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-LT, ((there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))	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 has a valid, non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-LT, ((there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))
02/05/2021	3.0.0	RULE-1540	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-OT, ((there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '2', 'B', 'V' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-OT, ((there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))
02/05/2021	3.0.0	RULE-1845	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, ((there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE, PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, ((there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE, PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))
02/05/2021	3.0.0	RULE-810	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 is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-IP, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-IP, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))
02/05/2021	3.0.0	RULE-1246	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 is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' 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 has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-LT, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))	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-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 has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-LT, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))
02/05/2021	3.0.0	RULE-1663	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-OT, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '2', 'B', 'V' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-OT, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))
02/05/2021	3.0.0	RULE-1964	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE, PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))	if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE, PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))
04/30/2021	3.0.0	RULE-7458	ADD	Data Dictionary - Validation Rules	N/A	if WAIVER-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM and WAIVER-PARTICIPATION.WAIVER-TYPE is equal to one of the following: '01', '21', '22', '23', '24', '25', '26', '27','28', '29', '30' then substr(WAIVER-PARTICIPATION.WAIVER-ID, 1, 5) must be in ('11-W-' or '21-W-') and substr(WAIVER-PARTICIPATION.WAIVER-ID, 6, 5) must be equal to 0-9 digits and substr(WAIVER-PARTICIPATION.WAIVER-ID, 11, 1) must be equal to '/' and substr(WAIVER-PARTICIPATION.WAIVER-ID, 12, 1) must be equal to 0-9 digits)
04/30/2021	3.0.0	RULE-7459	ADD	Data Dictionary - Validation Rules	N/A	if WAIVER-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM and WAIVER-TYPE is equal to one of the following: '02', '03', '04', '05', '06', '07', '08','09', '10', '11, '12', '13', '14', '15', '16', '17', '18','19', '20', '32', '33' then substr(WAIVER-PARTICIPATION.WAIVER-ID, 1, 2) must be in (A-Z/a-z) and substr(WAIVER-PARTICIPATION.WAIVER-ID, 3, 1) must be equal to '.' and substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 7) must be equal to 0-9 digits)
04/30/2021	3.0.0	RULE-7460	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT.HCBS-SERVICE-CODE is equal to '4' then CLAIM-HEADER-RECORD-OT has a non-null value for WAIVER-ID
01/27/2021	3.0.0	PROCEDURE-CODE-FLAG	UPDATE	Data Dictionary - Valid Values	ICD-10 - CM PCS	ICD-10 - PCS
01/27/2021	3.0.0	RULE-2051	UPDATE	Data Dictionary - Validation Rules	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CITIZENSHIP-IND equals '1', then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.IMMIGRATION-STATUS equals '8''	‘if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CITIZENSHIP-IND is equal to one of the following: '1', '2’ then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.IMMIGRATION-STATUS equals '8''
01/27/2021	3.0.0	RULE-2157	UPDATE	Data Dictionary - Validation Rules	if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '2', then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CITIZENSHIP-IND does not equal '1''	if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '2', and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CITIZENSHIP-IND is not equal to one of the following: '1', '2'
08/13/2021	3.0.0	OPERATING-AUTHORITY (MCR067)	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|OPERATING-AUTHORITY\|00010101\|99991231\|16\|Concurrent 1915(a)/1915(j) - programs, or portions thereof, operating under both 1915(a) and 1915(j) authorities\| \|OPERATING-AUTHORITY\|00010101\|99991231\|17\|Concurrent 1932(a)/1915(j) - programs, or portions thereof, operating under both 1932(a) and 1915(j) authorities\| \|OPERATING-AUTHORITY\|00010101\|99991231\|18\|Concurrent 1915(b)/1915(j) - programs, or portions thereof, operating under both 1915(b) and 1915(j) authorities\| \|OPERATING-AUTHORITY\|00010101\|99991231\|19\|Concurrent 1115/1915(j) - programs, or portions thereof, operating under both 1115 and 1915(j) authorities\| \|OPERATING-AUTHORITY\|00010101\|99991231\|20\|Concurrent 1915(a)/1915(k) - programs, or portions thereof, operating under both 1915(a) and 1915(k) authorities\| \|OPERATING-AUTHORITY\|00010101\|99991231\|21\|Concurrent 1932(a)/1915(k) - programs, or portions thereof, operating under both 1932(a) and 1915(k) authorities\| \|OPERATING-AUTHORITY\|00010101\|99991231\|22\|Concurrent 1915(b)/1915(k) - programs, or portions thereof, operating under both 1915(b) and 1915(k) authorities\| \|OPERATING-AUTHORITY\|00010101\|99991231\|23\|Concurrent 1115/1915(k) - programs, or portions thereof, operating under both 1115 and 1915(k) authorities\|
06/24/2022	3.0.0	STATE-SPEC-ELIG-GROUP	UPDATE	Data Dictionary	DE No\|Data Element Name\|CODING REQUIREMENT\| ELG093\|STATE-SPEC-ELIG-GROUP\|If value is in the range [ 000000 .. 999999 ], then associated Date of Death value must not be before the start of the reporting period.\|	DE No\|Data Element Name\|CODING REQUIREMENT\| ELG093\|STATE-SPEC-ELIG-GROUP\|\|
02/26/2021	3.0.0	RULE-7464	ADD	Data Dictionary - Validation Rules	N/A	For every record of type CLAIM-HEADER-RECORD-IP, ADJUSTMENT-IND must have a non-null value'
02/26/2021	3.0.0	RULE-7465	ADD	Data Dictionary - Validation Rules	N/A	For every record of type CLAIM-HEADER-RECORD-LT, ADJUSTMENT-IND must have a non-null value'
02/26/2021	3.0.0	RULE-7466	ADD	Data Dictionary - Validation Rules	N/A	For every record of type CLAIM-HEADER-RECORD-OT, ADJUSTMENT-IND must have a non-null value'
02/26/2021	3.0.0	RULE-7467	ADD	Data Dictionary - Validation Rules	N/A	For every record of type CLAIM-HEADER-RECORD-RX, ADJUSTMENT-IND must have a non-null value'
02/26/2021	3.0.0	RULE-7468	ADD	Data Dictionary - Validation Rules	N/A	For every record of type CLAIM-LINE-RECORD-IP, LINE-ADJUSTMENT-IND must have a non-null value'
02/26/2021	3.0.0	RULE-7469	ADD	Data Dictionary - Validation Rules	N/A	For every record of type CLAIM-LINE-RECORD-LT, LINE-ADJUSTMENT-IND must have a non-null value'
02/26/2021	3.0.0	RULE-7470	ADD	Data Dictionary - Validation Rules	N/A	For every record of type CLAIM-LINE-RECORD-OT, LINE-ADJUSTMENT-IND must have a non-null value'
02/26/2021	3.0.0	RULE-7471	ADD	Data Dictionary - Validation Rules	N/A	For every record of type CLAIM-LINE-RECORD-RX, LINE-ADJUSTMENT-IND must have a non-null value'
02/26/2021	3.0.0	RULE-2133	ADD	Data Dictionary - Validation Rules	N/A	If there is only one ELIGIBILITY-DETERMINANTS-ELG00005 record segment identified via segment key data elements SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, and MSIS-CASE-NUM, then PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
05/13/2022	3.0.0	ELG087	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT\| ELG087\|ELIGIBILITY-GROUP\|Beneficiaries reported with ELIGIBILITY-GROUP="72", "73", "74", "75" are expected to be covered by an alternative benefit plan and should be reported with RESTRICTED-BENEFITS-CODE=7 and STATE-PLAN-OPTION-TYPE="06".	DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT\| ELG087\|ELIGIBILITY-GROUP\|Beneficiaries reported with ELIGIBILITY-GROUP="72", "73", "74", "75" are expected to be covered by an alternative benefit plan and should be reported with STATE-PLAN-OPTION-TYPE="06” and either RESTRICTED-BENEFITS-CODE=”1” or "7".
05/13/2022	3.0.0	ELG097	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT\| ELG097\|RESTRICTED-BENEFITS-CODE\|\|	DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT\| ELG097\|RESTRICTED-BENEFITS-CODE\|Beneficiaries reported with ELIGIBILITY-GROUP="72", "73", "74", "75" are expected to be covered by an alternative benefit plan and should be reported with STATE-PLAN-OPTION-TYPE="06” and either RESTRICTED-BENEFITS-CODE=”1” or "7".\|
05/13/2022	3.0.0	ELG163	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT\| ELG163\|STATE-PLAN-OPTION-TYPE\|Beneficiaries reported with ELIGIBILITY-GROUP="72", "73", "74", "75" are expected to be covered by an alternative benefit plan and should be reported with RESTRICTED-BENEFITS-CODE=7 and STATE-PLAN-OPTION-TYPE="06”.\|	DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT\| ELG163\|STATE-PLAN-OPTION-TYPE\|Beneficiaries reported with ELIGIBILITY-GROUP="72", "73", "74", "75" are expected to be covered by an alternative benefit plan and should be reported with STATE-PLAN-OPTION-TYPE="06” and either RESTRICTED-BENEFITS-CODE=”1” or "7".\|
02/05/2021	3.0.0	RULE-1372	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	‘if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal ‘F2',and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal ‘0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: ‘26’, ‘87’, ‘542’, '585’, '654’, '686’ and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' then if the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
02/26/2021	3.0.0	XIX-MBESCBES-CATEGORY-OF-SERVICE	ADD	Data Dictionary - Valid Values	N/A	\|Valid Value ID\|Effective Date\|End Date\|Value\|Description\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20201001\|99991231\|46\|OUD Medicaid Assisted Treatment – Drugs\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20201001\|99991231\|46A1\| OUD MAT DRUG REBATE/National Agreement\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20201001\|99991231\|46A2\|OUD MAT DRUG REBATE/State Sidebar\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20201001\|99991231\|46A3\| OUD MAT DRUG REBATE MCO /National Agreement\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20201001\|99991231\|46A4\| OUD MAT DRUG REBATE MCO /State Sidebar\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20201001\|99991231\|46A5\| OUD MAT DRUG REBATE/Increased ACA Offset Fee for Service - 100%\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20201001\|99991231\|46A6\| OUD MAT DRUG REBATE/Increased ACA Offset MCO – 100%\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20201001\|99991231\|46B\| OUD Medicaid Assisted Treatment Services\|
05/13/2022	3.0.0	COT123	UPDATE	Data Dictionary - Valid Values	Replace VVL.178 - Place of Service Code List	https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set
07/02/2021	3.0.0	RULE-7447	UPDATE	Data Dictionary - Validation Rules	'if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1', then ELIGIBILITY-DETERMINANTS has a non-null value for ELIGIBILITY-GROUP'	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '01/01/2015' then ELIGIBILITY-DETERMINANTS has a non-null value for ELIGIBILITY-GROUP'
07/02/2021	3.0.0	RULE-7411	UPDATE	Data Dictionary - Validation Rules	if ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and ENROLLMENT-TIME-SPAN-SEGMENT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ENROLLMENT-TIME-SPAN-SEGMENT has a non-null and not invalidly formatted value for ENROLLMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT has a non-null and not invalidly formatted value for ENROLLMENT-END-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE are overlapping with ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '6',	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to '6' and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '01/01/2015' then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP is equal to one of the following: '35', '70
02/26/2021	3.0.0	IMMIGRATION-VERIFICATION-FLAG	UPDATE	Data Dictionary - Valid Values	\|Value ID\|Value\|Description\| \|IMMIGRATION-VERIFICATION-FLAG\|0\|No\| \|IMMIGRATION-VERIFICATION-FLAG\|1\|Yes\|	\|Value ID\|Value\|Description\| \|IMMIGRATION-VERIFICATION-FLAG\|0\|Immigration Status Verified\| \|IMMIGRATION-VERIFICATION-FLAG\|1\|Enrolled in Medicaid pending immigration verification\|
06/24/2022	3.0.0	CIP107/ ALLOWED-CHARGE-SRC	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP107\|ALLOWED-CHARGE-SRC\| X(1)\|CLAIMIP\|CLAIM-LINE-RECORD-IP-CIP00003	N/A
02/26/2021	3.0.0	RECORD-ID	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|DESCRIPTION\| \|RECORD-ID\|00010101\|99991231\|ELG00022\|ELG-IDENTIFIERS\|
02/26/2021	3.0.0	TYPE-OF-HOSPITAL	UPDATE	Data Dictionary - Valid Values	\|Value ID\|Effective Date\|End Date\|Value\|Description\| \|TYPE-OF-HOSPITAL\|0010101\|99991231\|99\|Unknown\|	End date valid value '99'
02/26/2021	3.0.0	AMERICAN-INDIAN-ALASKA-NATIVE-INDICATOR	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR\|00010101\|99991231\|0\|Not applicable\| \| \|CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR\|00010101\|99991231\|1\|No, Individual does not have CDIB\| \| \|CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR\|00010101\|20200214\|2\|Yes, Individual does have CDIB\| \|	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR\|00010101\|99991231\|0\|Individual does not meet the definition of an American Indian/Alaska Native.\| \| \|CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR\|00010101\|99991231\|1\|Individual meets the definition of an American Indian/Alaska Native.\| \| No update is required for value '2'. This value is end dated on 2/24/2020.
02/26/2021	3.0.0	CITIZENSHIP-VERIFICATION-FLAG	UPDATE	Data Dictionary - Valid Values	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|CITIZENSHIP-VERIFICATION-FLAG\|00010101\|99991231\|0\|No\| \| \|CITIZENSHIP-VERIFICATION-FLAG\|00010101\|99991231\|1\|Yes\| \|	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|CITIZENSHIP-VERIFICATION-FLAG\|00010101\|99991231\|0\|Citizenship Verified\| \| \|CITIZENSHIP-VERIFICATION-FLAG\|00010101\|99991231\|1\|Enrolled in Medicaid pending citizenship verification\| \|
06/24/2022	3.0.0	PRV110/ SUBMITTING-STATE-PROV-ID-OF-AFFILIATED-ENTITY	Modify DE Width	Data Dictionary - Record Layout	SIZE X(12)	SIZE X(30)
03/19/2021	3.0.0	ELIGIBILITY-GROUP	UPDATE	Data Dictionary - Valid Values	\|Data Element\|Effective Date\|End Date\|Value\|Name\| \|ELIGIBILITY-GROUP\|00010101\|99991231\|10\|Non-pregnant individuals aged 19 through 64, not otherwise mandatorily eligible, with income at or below 133% FPL.\|	N/A
03/19/2021	3.0.0	XIX-MBESCBES-CATEGORY-OF-SERVICE	UPDATE	Data Dictionary - Valid Values	\|Data Element\|Effective Date\|End Date\|Value\|Name\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|50\|Total\|	N/A
03/19/2021	3.0.0	XXI-MBESCBES-CATEGORY-OF-SERVICE	UPDATE	Data Dictionary - Valid Values	\|Data Element\|Effective Date\|End Date\|Value\|Name\| \|XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|48\|Balance\| \|XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|49\|Less: Collections\| \|XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|50\|Total\|	N/A
04/30/2021	3.0.0	RULE-3089	UPDATE	Data Dictionary - Validation Rules	if TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for GROUP-NUM, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.GROUP-NUM does not contain any pipe (\|) or asterisk (*) characters'	‘if TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for GROUP-NUM, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.GROUP-NUM does not contain any pipe (\|) characters’
04/30/2021	3.0.0	RULE-3090	UPDATE	Data Dictionary - Validation Rules	if TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for MEMBER-ID, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.MEMBER-ID does not contain any pipe (\|) or asterisk (*) characters'	‘if TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for MEMBER-ID, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.MEMBER-ID does not contain any pipe (\|) characters’
04/30/2021	3.0.0	RULE-3094	UPDATE	Data Dictionary - Validation Rules	if TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for POLICY-OWNER-FIRST-NAME, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.POLICY-OWNER-FIRST-NAME does not contain any pipe (\|) or asterisk (*) characters'	if TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for POLICY-OWNER-FIRST-NAME, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.POLICY-OWNER-FIRST-NAME does not contain any pipe (\|) characters'
04/30/2021	3.0.0	RULE-3095	UPDATE	Data Dictionary - Validation Rules	if TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for POLICY-OWNER-LAST-NAME, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.POLICY-OWNER-LAST-NAME does not contain any pipe (\|) or asterisk (*) characters'	if TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for POLICY-OWNER-LAST-NAME, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.POLICY-OWNER-LAST-NAME does not contain any pipe (\|) characters'
03/19/2021	3.0.0	RULE-7372	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP has a null value 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 and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
03/19/2021	3.0.0	RULE-7373	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 one of the following: '1', '5' 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 TOT-MEDICAID-PAID-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 equals '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 one of the following: '1', '5' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT has a null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 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 equals '01', then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
03/19/2021	3.0.0	RULE-7374	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '2', '5' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
03/19/2021	3.0.0	RULE-7375	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
03/19/2021	3.0.0	RULE-7376	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP has a null value 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 and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
03/19/2021	3.0.0	RULE-7377	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 one of the following: 'A', 'E' 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 TOT-MEDICAID-PAID-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 equals '02', then 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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT has a null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 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 equals '02', then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
03/19/2021	3.0.0	RULE-7378	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', 'B', 'E' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', 'B', 'E' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
03/19/2021	3.0.0	RULE-7379	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
05/21/2021	3.0.0	RULE-7472	ADD	Data Dictionary - Validation Rules	N/A	if PROV-IDENTIFIERS has a non-null value for PROV-IDENTIFIER and PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2', then PROV-IDENTIFIERS.PROV-IDENTIFIER is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
05/21/2021	3.0.0	RULE-7473	ADD	Data Dictionary - Validation Rules	N/A	if PROV-IDENTIFIERS has a non-null value for PROV-IDENTIFIER and PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2', then PROV-IDENTIFIERS.PROV-IDENTIFIER is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file and PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE is greater than or equal to "Provider Enumeration Date" from the NPPES NPI data file
04/09/2021	3.0.0	RULE-7513	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z' then CLAIM-HEADER-RECORD-IP has a null value for SERVICE-TRACKING-TYPE or CLAIM-HEADER-RECORD-IP.SERVICE-TRACKING-TYPE is equal to one of the following: '0', '00'
04/09/2021	3.0.0	RULE-7514	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.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 not equal to one of the following: '4', 'D', 'X', 'Z' then CLAIM-HEADER-RECORD-LT has a null value for SERVICE-TRACKING-TYPE or CLAIM-HEADER-RECORD-LT.SERVICE-TRACKING-TYPE is equal to one of the following: '0', '00'
04/09/2021	3.0.0	RULE-7515	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z' then CLAIM-HEADER-RECORD-OT has a null value for SERVICE-TRACKING-TYPE or CLAIM-HEADER-RECORD-OT.SERVICE-TRACKING-TYPE is equal to one of the following: '0', '00'
04/09/2021	3.0.0	RULE-7516	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z' then CLAIM-HEADER-RECORD-RX has a null value for SERVICE-TRACKING-TYPE or CLAIM-HEADER-RECORD-RX.SERVICE-TRACKING-TYPE is equal to one of the following: '0', '00'
04/30/2021	3.0.0	RULE-7517	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z' then (CLAIM-HEADER-RECORD-IP has a null a value for SERVICE-TRACKING-PAYMENT-AMT) or (CLAIM-HEADER-RECORD-IP.SERVICE-TRACKING-PAYMENT-AMT is equal to 0.00)
04/30/2021	3.0.0	RULE-7518	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-IP.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 not equal to one of the following: '4', 'D', 'X', 'Z' then (CLAIM-HEADER-RECORD-LT has a null value for SERVICE-TRACKING-PAYMENT-AMT) or (CLAIM-HEADER-RECORD-LT.SERVICE-TRACKING-PAYMENT-AMT is equal to 0.00)
04/30/2021	3.0.0	RULE-7519	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z' then (CLAIM-HEADER-RECORD-OT has a null value for SERVICE-TRACKING-PAYMENT-AMT) or (CLAIM-HEADER-RECORD-OT.SERVICE-TRACKING-PAYMENT-AMT is equal to 0.00)
04/30/2021	3.0.0	RULE-7520	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z' then (CLAIM-HEADER-RECORD-RX has a null value for SERVICE-TRACKING-PAYMENT-AMT) or (CLAIM-HEADER-RECORD-RX.SERVICE-TRACKING-PAYMENT-AMT is equal to 0.00)
04/09/2021	3.0.0	CHIP-CODE (ELG054)	UPDATE	Data Dictionary	CHIP-CODE (ELG054) v2.3 Definition: A code used to distinguish among Medicaid, Medicaid Expansion, and Separate CHIP populations	A code used to distinguish among Medicaid, Medicaid Expansion CHIP, and Separate CHIP populations
04/09/2021	3.0.0	RULE-7521	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', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-IP has a non-null value for SERVICE-TRACKING-TYPE'
04/30/2021	3.0.0	DIAGNOSIS-POA-FLAG	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION DIAGNOSIS-POA-FLAG\|00010101\|99991231\|N\|Diagnosis was not present at time of inpatient admission\| DIAGNOSIS-POA-FLAG\|00010101\|99991231\|U\|Documentation insufficient to determine if condition was present at the time of inpatient admission\| DIAGNOSIS-POA-FLAG\|00010101\|99991231\|W\|Clinically undetermined. Provider unable to clinically determine whether the condition was present at the time of inpatient admission.\| DIAGNOSIS-POA-FLAG\|00010101\|99991231\|Y\|Diagnosis was present at time of inpatient admission\|	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| DIAGNOSIS-POA-FLAG\|00010101\|99991231\|N\|Diagnosis was not present at time of inpatient admission\| DIAGNOSIS-POA-FLAG\|00010101\|99991231\|U\|Documentation insufficient to determine if condition was present at the time of inpatient admission\| DIAGNOSIS-POA-FLAG\|00010101\|99991231\|W\|Clinically undetermined. Provider unable to clinically determine whether the condition was present at the time of inpatient admission.\| DIAGNOSIS-POA-FLAG\|00010101\|99991231\|Y\|Diagnosis was present at time of inpatient admission\| DIAGNOSIS-POA-FLAG\|00010101\|99991231\|1\|Unreported/Not used. Exempt from POA reporting.\|
04/09/2021	3.0.0	MEDICAID-BASIS-OF-ELIGIBILITY	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MEDICAID-BASIS-OF-ELIGIBILITY\|00010101\|99991231\|00\|Individual was not eligible for Medicaid at any time during the month\|	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION MEDICAID-BASIS-OF-ELIGIBILITY\|00010101\|99991231\|00\|Individual was not eligible for Medicaid (or Medicaid-expansion CHIP) at any time during the month, and Individual was eligible for separate CHIP\|
04/30/2021	3.0.0	DRUG-UTILIZATION-CODE	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| DRUG-UTILIZATION-CODE-E4\|00010101\|99991231\|SC\|Suboptimal Compliance\| DRUG-UTILIZATION-CODE-E4\|00010101\|99991231\|SD\|Suboptimal Drug/Indication\| DRUG-UTILIZATION-CODE-E4\|00010101\|99991231\|SE\|Side Effect\| DRUG-UTILIZATION-CODE-E4\|00010101\|99991231\|SF\|Suboptimal Dosage Form\| DRUG-UTILIZATION-CODE-E4\|00010101\|99991231\|SX\|Drug-Gender\| DRUG-UTILIZATION-CODE-E4\|00010101\|99991231\|TN\|Laboratory Test Needed\| DRUG-UTILIZATION-CODE-E4\|00010101\|99991231\|TP\|Payer/Processor Question\|
04/09/2021	3.0.0	RULE-1244	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '009', '044', '045', '046', '047', '048', '050', '059', '133', '136', '137''	if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '009', '044', '045', '046', '047', '048', '050', '059', '133', '136', '137', '146''
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
04/30/2021	3.0.0	RULE-7523	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is not equal to 0.00'
04/30/2021	3.0.0	RULE-7524	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not equal to 0.00'
04/30/2021	3.0.0	XIX-MBESCBES-CATEGORY-OF-SERVICE	ADD	Data Dictionary - Valid Values	N/A	\|Valid Value\|Effective Date\|End Date\|Name\| \|2C\|00010101\|99991231\|Certified Community Behavior Health Clinic Payments\| \|18A5\|00010101\|99991231\|Medicaid MCO - Certified Community Behavior Health Clinic Payments\| \|18B1e\|00010101\|99991231\|Medicaid PAHP - Certified Community Behavior Health Clinic Payments\| \|18B2e\|00010101\|99991231\|Medicaid PIHP - Certified Community Behavior Health Clinic Payments\| \|46\|00010101\|99991231\|OUD Medicaid Assisted Treatment – Drugs\| \|46A1\|00010101\|99991231\|OUD MAT DRUG REBATE/National Agreement\| \|46A2\|00010101\|99991231\|OUD MAT DRUG REBATE/State Sidebar\| \|46A3\|00010101\|99991231\|OUD MAT DRUG REBATE MCO /National Agreement\| \|46A4\|00010101\|99991231\|OUD MAT DRUG REBATE MCO /State Sidebar\| \|46A5\|00010101\|99991231\|OUD MAT DRUG REBATE/Increased ACA Offset Fee for Service - 100%\| \|46A6\|00010101\|99991231\|OUD MAT DRUG REBATE/Increased ACA Offset MCO – 100%\| \|46B\|00010101\|99991231\|OUD Medicaid Assisted Treatment Services\|
04/30/2021	3.0.0	RULE-1651	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'C', '3', 'W', then CLAIM-LINE-RECORD-OT has a valid, non-null value for MEDICAID-FFS-EQUIVALENT-AMT'	N/A
04/30/2021	3.0.0	RULE-804	UPDATE	Data Dictionary - Validation Rules	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' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: 'C', '3', 'W', then CLAIM-LINE-RECORD-IP has a valid, non-null value for MEDICAID-FFS-EQUIVALENT-AMT'	N/A
04/30/2021	3.0.0	RULE-1930	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'C', '3', 'W', then CLAIM-LINE-RECORD-RX has a valid, non-null value for MEDICAID-FFS-EQUIVALENT-AMT'	N/A
04/30/2021	3.0.0	RULE-1241	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'C', '3', 'W', then CLAIM-LINE-RECORD-LT has a valid, non-null value for MEDICAID-FFS-EQUIVALENT-AMT'	N/A
05/13/2022	3.0.0	CIP202, CLT144, COT126, CRX081	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME\|DEFINITION\| CIP202\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount. The RA number is not the check number.\| CLT144\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount. The RA number is not the check number.\| COT126\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount. The RA number is not the check number.\| CRX081\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount. The RA number is not the check number.\|	DE NO\| DATA ELEMENT NAME\|DEFINITION\| CIP202\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount.\| CLT144\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount.\| COT126\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount.\| CRX081\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount.\|
05/21/2021	3.0.0	RULE-7528	ADD	Data Dictionary - Validation Rules	N/A	‘if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.IMMIGRATION-STATUS equals '8' then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CITIZENSHIP-IND is equal to one of the following: '1', '2’
05/21/2021	3.0.0	RULE-7531	ADD	Data Dictionary - Validation Rules	N/A	If ENROLLMENT-TIME-SPAN has a non-null value for MSIS-IDENTIFICATION-NUM then for every record of type ENROLLMENT-TIME-SPAN, there must be a valid record of type ELIGIBLE-CONTACT-INFORMATION that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) and ELIGIBLE-CONTACT-INFORMATION.ADDR-TYPE is equal to '01'
04/30/2021	3.0.0	RULE-335	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 is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys	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 is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W'and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys
04/30/2021	3.0.0	RULE-1758	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W'and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys
04/30/2021	3.0.0	PROCEDURE-CODE-FLAG	UPDATE	Data Dictionary - Valid Values	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|PROCEDURE-CODE-FLAG\|00010101\|99991231\|06\|HCPCS (Both National and Regional HCPCS)\|	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|PROCEDURE-CODE-FLAG\|00010101\|99991231\|06\|HCPCS Level II and CDT\|
05/21/2021	3.0.0	RULE-2726	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE	N/A
05/21/2021	3.0.0	RULE-2750	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE	N/A
06/24/2022	3.0.0	CLAIM-STATUS-CATEGORY	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Coding Requirement\| \|CIP103,CLT.055,COT.040,CRX.031\|CLAIM-STATUS-CATEGORY\|(Denied Claim) if associated Type of Claim equals Z or associated Claim Status is in [ 26, 87, 542, 858, 654 ], then value must be "F2"	\|DE No\|Data Element Name\|Coding Requirement\| \|CIP103,CLT055,COT040,CRX031\|CLAIM-STATUS-CATEGORY\|(Denied Claim) if associated Type of Claim equals Z or associated Claim Status is in [ 26, 87, 542, 585, 654 ], then value must be "F2"
05/13/2022	3.0.0	CRX144	UPDATE	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX144\|DTL-METRIC-DEC-QTY\|Conditional\|Metric decimal quantity of the product with the appropriate unit of measure (each, gram, or milliliter).\|1. Value must be numeric, 2. Value may include up to 7 digits to the left of the decimal point, and 3 digits to the right, e.g. 1234567.890, 3. Value must be populated when Compound Drug Indicator (CRX.002.086) equals 1, 4.Conditional\|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003
05/13/2022	3.0.0	CRX098	UPDATE	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX098\|THIRD-PARTY-COINSURANCE-AMOUNT-PAID\|Optional\|The amount of money paid by a third party on behalf of the beneficiary towards coinsurance.\|1. Value must be between -99999999999.99 and 99999999999.99, 2. Value must be expressed as a number with 2-digit precision (e.g. 100.50 ), 3.Optional\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002
12/17/2021	3.0.0	PRIMARY-LANGUAGE-CODE (ELG046)	UPDATE	Data Dictionary	\|DE NO\|DEFINITION\| \|ELG046\|A code indicating the language the individual speaks other than English at home.\|	\|DE NO\|DEFINITION\| \|ELG046\|A code indicating the language that is the individuals' preferred spoken or written language.\|
06/24/2022	3.0.0	CIP201/ BMI	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP201\|BMI\|S9(5)V9\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002	N/A
06/24/2022	3.0.0	CLT143/ BMI	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CLT143\|BMI\|S9(5)V9\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002	N/A
06/24/2022	3.0.0	COT125/ BMI	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT125\|BMI\|S9(5)V9\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002	N/A
06/24/2022	3.0.0	CRX103/ DISPENSING-PRESCRIPTION-DRUG-PROV-TAXONOMY	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX103\|DISPENSING-PRESCRIPTION-DRUG-PROV-TAXONOMY\|X(12)\|CLAIMOT\|CLAIM-HEADER-RECORD-RX-CRX00002	N/A
06/24/2022	3.0.0	COT220/ HCPCS-RATE	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT220\|HCPCS-RATE\|X(14)\|CLAIMOT\|CLAIM-LINE-RECORD-OT-COT00003	N/A
06/24/2022	3.0.0	CIP131/ NATIONAL-HEALTH-CARE-ENTITY-ID	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP131\|NATIONAL-HEALTH-CARE-ENTITY-ID\|X(10)\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002	N/A
06/24/2022	3.0.0	CLT081/ NATIONAL-HEALTH-CARE-ENTITY-ID	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CLT081\|NATIONAL-HEALTH-CARE-ENTITY-ID\|X(10)\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002	N/A
06/24/2022	3.0.0	COT067/ NATIONAL-HEALTH-CARE-ENTITY-ID	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT067\|NATIONAL-HEALTH-CARE-ENTITY-ID\|X(10)\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002	N/A
06/24/2022	3.0.0	CRX057/ NATIONAL-HEALTH-CARE-ENTITY-ID	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX057\|NATIONAL-HEALTH-CARE-ENTITY-ID\|X(10)\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002	N/A
06/24/2022	3.0.0	CRX078/ PRESCRIBING-PROV-SPECIALTY	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX078\|PRESCRIBING-PROV-SPECIALTY\|X(2)\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002	N/A
06/24/2022	3.0.0	CRX076/ PRESCRIBING-PROV-TAXONOMY	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX076\|PRESCRIBING-PROV-TAXONOMY\|X(12)\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002	N/A
06/24/2022	3.0.0	CRX077/ PRESCRIBING-PROV-TYPE	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX077\|PRESCRIBING-PROV-TYPE\|X(2)\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002	N/A
06/24/2022	3.0.0	CIP253/ TPL-AMT	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP253\|TPL-AMT\|S9(11)V99	N/A
06/24/2022	3.0.0	CLT137/ REFERRING-PROV-TAXONOMY	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CLT137\|REFERRING-PROV-TAXONOMY\|X(12)\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002	N/A
06/24/2022	3.0.0	CLT138/ REFERRING-PROV-TYPE	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CLT138\|REFERRING-PROV-TYPE\|X(2)\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002	N/A
06/24/2022	3.0.0	CLT139/ REFERRING-PROV-SPECIALTY	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CLT139\|REFERRING-PROV-SPECIALTY\|X(2)\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002	N/A
06/24/2022	3.0.0	CLT169/ UNDER-DIRECTION-OF-PROV-NPI	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CLT169\|UNDER-DIRECTION-OF-PROV-NPI\|X(12)\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002	N/A
06/24/2022	3.0.0	CLT170/ UNDER-DIRECTION-OF-PROV-TAXONOMY	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CLT170\|UNDER-DIRECTION-OF-PROV-TAXONOMY\|X(12)\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002	N/A
06/24/2022	3.0.0	CLT171/ UNDER-SUPERVISION-OF-PROV-NPI	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CLT171\|UNDER-SUPERVISION-OF-PROV-NPI\|X(12)\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002	N/A
06/24/2022	3.0.0	CLT172/ UNDER-SUPERVISION-OF-PROV-TAXONOMY	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CLT172\|UNDER-SUPERVISION-OF-PROV-TAXONOMY\|X(12)\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002	N/A
06/24/2022	3.0.0	CIP193/ REFERRING-PROV-SPECIALTY	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP193\|REFERRING-PROV-SPECIALTY\|X(2)\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002	N/A
06/24/2022	3.0.0	COT121/ REFERRING-PROV-SPECIALTY	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT121\|REFERRING-PROV-SPECIALTY\|X(2)\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002	N/A
06/24/2022	3.0.0	CIP191/ REFERRING-PROV-TAXONOMY	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP191\|REFERRING-PROV-TAXONOMY\|X(12)\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002	N/A
06/24/2022	3.0.0	COT119/ REFERRING-PROV-TAXONOMY	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT119\|REFERRING-PROV-TAXONOMY\|X(12)\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002	N/A
06/24/2022	3.0.0	CIP192/ REFERRING-PROV-TYPE	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP192\|REFERRING-PROV-TYPE\|X(2)\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002	N/A
06/24/2022	3.0.0	COT120/ REFERRING-PROV-TYPE	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT120\|REFERRING-PROV-TYPE\|X(2)\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002	N/A
06/24/2022	3.0.0	CIP262/ SERVICING-PROV-TAXONOMY	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP262\|SERVICING-PROV-TAXONOMY\|X(12)\|CLAIMIP\|CLAIM-LINE-RECORD-IP-CIP00003	N/A
06/24/2022	3.0.0	CLT214/ SERVICING-PROV-TAXONOMY	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CLT214\|SERVICING-PROV-TAXONOMY\|X(12)\|CLAIMLT\|CLAIM-LINE-RECORD-LT-CLT00003	N/A
06/24/2022	3.0.0	CIP224/ UNDER-DIRECTION-OF-PROV-NPI	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP224\|UNDER-DIRECTION-OF-PROV-NPI\|X(10)\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002	N/A
06/24/2022	3.0.0	COT148/ UNDER-DIRECTION-OF-PROV-NPI	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT148\|UNDER-DIRECTION-OF-PROV-NPI\|X(10)\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002	N/A
06/24/2022	3.0.0	CIP225/ UNDER-DIRECTION-OF-PROV-TAXONOMY	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP225\|UNDER-DIRECTION-OF-PROV-TAXONOMY\|X(12)\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002	N/A
06/24/2022	3.0.0	COT149/ UNDER-DIRECTION-OF-PROV-TAXONOMY	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT149\|UNDER-DIRECTION-OF-PROV-TAXONOMY\|X(12)\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002	N/A
06/24/2022	3.0.0	CIP226/ UNDER-SUPERVISION-OF-PROV-NPI	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP226\|UNDER-SUPERVISION-OF-PROV-NPI\|X(10)\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002	N/A
06/24/2022	3.0.0	CIP227/ UNDER-SUPERVISION-OF-PROV-TAXONOMY	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP227\|UNDER-SUPERVISION-OF-PROV-TAXONOMY\|X(12)\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002	N/A
06/24/2022	3.0.0	COT151/ UNDER-SUPERVISION-OF-PROV-TAXONOMY	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT151\|UNDER-SUPERVISION-OF-PROV-TAXONOMY\|X(12)\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002	N/A
06/24/2022	3.0.0	ELG194/ NATIONAL-HEALTH-CARE-ENTITY-ID	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT ELG194\|NATIONAL-HEALTH-CARE-ENTITY-ID\|X(10)\|ELIGIBLE\|MANAGED-CARE-PARTICIPATION-ELG00014	N/A
06/24/2022	3.0.0	ELG195/ NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT ELG195\|NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE\|X(1)\|ELIGIBLE\|MANAGED-CARE-PARTICIPATION-ELG00014	N/A
06/24/2022	3.0.0	TPL092/ NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT TPL092\|NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE\|X(1)\|TPL\|TPL-ENTITY-CONTACT-INFORMATION-TPL00006	N/A
06/24/2022	3.0.0	TPL093/ NATIONAL-HEALTH-CARE-ENTITY-ID	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT TPL093\|NATIONAL-HEALTH-CARE-ENTITY-ID\|X(10)\|TPL\|TPL-ENTITY-CONTACT-INFORMATION-TPL00006	N/A
06/24/2022	3.0.0	TPL094/ NATIONAL-HEALTH-CARE-ENTITY-NAME	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT TPL094\|NATIONAL-HEALTH-CARE-ENTITY-NAME\|X(50)\|TPL\|TPL-ENTITY-CONTACT-INFORMATION-TPL00006	N/A
05/13/2022	3.0.0	CIP184, CLT006, COT006, CRX006, ELG006, MCR006, PRV006, TPL006, CIP127, CLT077, COT063, CRX054, ELG111, TPL044, TPL045, CIP093, CIP088, PRV043, PRV064, PRV076, PRV129, COT191	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME\|NECESSITY\| CIP184\|ADMITTING-PROV-NPI-NUM\|\| CLT006\|FILE-NAME\|\| CRX006\|FILE-NAME\|\| ELG006\|FILE-NAME\|\| MCR006\|FILE-NAME\|\| PRV006\|FILE-NAME\|\| TPL006\|FILE-NAME\|\| CIP127\|FUNDING-SOURCE-NONFEDERAL-SHARE\|\| CLT077\|FUNDING-SOURCE-NONFEDERAL-SHARE\|\| COT063\|FUNDING-SOURCE-NONFEDERAL-SHARE\|\| CRX054\|FUNDING-SOURCE-NONFEDERAL-SHARE\|\| ELG111\|HEALTH-HOME-ENTITY-EFF-DATE\|\| TPL044\|POLICY-OWNER-FIRST-NAME\|\| TPL045\|POLICY-OWNER-LAST-NAME\|\| CIP093\|PROCEDURE-CODE-DATE-6\|\| CIP088\|PROCEDURE-CODE-FLAG-5\|\| PRV043\|PROV-LOCATION-ID\|\| PRV064\|PROV-LOCATION-ID\|\| PRV076\|PROV-LOCATION-ID\|\| PRV129\|PROV-LOCATION-ID\|\| COT191\|SERVICING-PROV-TAXONOMY\|\|	DE NO\| DATA ELEMENT NAME\|NECESSITY\| CIP184\|ADMITTING-PROV-NPI-NUM\|Conditional\| CLT006\|FILE-NAME\|Mandatory\| CRX006\|FILE-NAME\|Mandatory\| ELG006\|FILE-NAME\|Mandatory\| MCR006\|FILE-NAME\|Mandatory\| PRV006\|FILE-NAME\|Mandatory\| TPL006\|FILE-NAME\|Mandatory\| CIP127\|FUNDING-SOURCE-NONFEDERAL-SHARE\|Conditional\| CLT077\|FUNDING-SOURCE-NONFEDERAL-SHARE\|Conditional\| COT063\|FUNDING-SOURCE-NONFEDERAL-SHARE\|Conditional\| CRX054\|FUNDING-SOURCE-NONFEDERAL-SHARE\|Conditional\| ELG111\|HEALTH-HOME-ENTITY-EFF-DATE\|Mandatory\| TPL044\|POLICY-OWNER-FIRST-NAME\|Mandatory\| TPL045\|POLICY-OWNER-LAST-NAME\|Mandatory\| CIP093\|PROCEDURE-CODE-DATE-6\|Conditional\| CIP088\|PROCEDURE-CODE-FLAG-5\|Conditional\| PRV043\|PROV-LOCATION-ID\|Mandatory\| PRV064\|PROV-LOCATION-ID\|Mandatory\| PRV076\|PROV-LOCATION-ID\|Mandatory\| PRV129\|PROV-LOCATION-ID\|Mandatory\| COT191\|SERVICING-PROV-TAXONOMY\|Conditional\|
06/24/2022	3.0.0	N/A	UPDATE	Data Dictionary	ELG00005.R.4 (FD2) an eligibility determinant segment (ELIGIBILITY-DETERMINANTS - ELG00005) with Primary Eligibility Group Indicator = 1 must exist for each timespan for which a person is eligible for Medicaid or CHIP.	ELG00005.R.4 (FD2) an eligibility determinant segment (ELG005) with Primary Eligibility Group Indicator = “1” must exist for each timespan for which a person is eligible for Medicaid or CHIP.
06/24/2022	3.0.0	HEALTH-HOME-CHRONIC-CONDITION-OTHER-EXPLANATION	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|ELG131\|HEALTH-HOME-CHRONIC-CONDITION-OTHER-EXPLANATION\|A free-text field to capture the description of the other chronic condition (or conditions) when value 'H' (Other) appears in the HEALTH-HOME-CHRONIC-CONDITION.\|	\|DE No\|Data Element Name\|Definition\| \|ELG131\|HEALTH-HOME-CHRONIC-CONDITION-OTHER-EXPLANATION\|A free-text field to capture the description of the other chronic condition (or conditions) when value “H” (Other) appears in the Health Home Chronic Condition data element.\|
06/24/2022	3.0.0	REASON-FOR-CHANGE	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|ELG266\|REASON-FOR-CHANGE\|A code to identify the reason for changing the MSIS Identification Number of a beneficiary and only required for ELG-IDENTIFIER-TYPE '2-Old MSIS Identification Number'. For example, If MSIS Identification Number of a beneficiary is being changed due to 'Merge with other MSIS ID' or 'Unmerge'.\|	\|DE No\|Data Element Name\|Definition\| \|ELG266\|REASON-FOR-CHANGE\|A code to identify the reason for changing the MSIS Identification Number of a beneficiary and only required for Eligibile Identifier Type = '2-Old MSIS Identification Number'. For example, If MSIS Identification Number of a beneficiary is being changed due to 'Merge with other MSIS ID' or 'Unmerge'.\|
06/24/2022	3.0.0	LICENSE-TYPE	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|PRV067\|LICENSE-TYPE\|A code to identify the kind of license or accreditation number that is captured in the LICENSE-OR-ACCREDITATION-NUMBER data element.\|	\|DE No\|Data Element Name\|Definition\| \|PRV067\|LICENSE-TYPE\|A code to identify the kind of license or accreditation number that is captured in the License or Accreditation Number data element.\|
06/24/2022	3.0.0	LICENSE-OR-ACCREDITATION-NUMBER	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|PRV069\|LICENSE-OR-ACCREDITATION-NUMBER\|A data element to capture the license or accreditation number issued to the provider by the licensing entity or accreditation body identified in the LICENSE-ISSUING-ENTITY-ID data element.\|	\|DE No\|Data Element Name\|Definition\| \|PRV069\|LICENSE-OR-ACCREDITATION-NUMBER\|A data element to capture the license or accreditation number issued to the provider by the licensing entity or accreditation body identified in the License Issuing Entity ID data element.\|
06/24/2022	3.0.0	PROV-IDENTIFIER-ISSUING-ENTITY-ID	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|PRV078\|PROV-IDENTIFIER-ISSUING-ENTITY-ID\| A free text field to capture the identity of the entity that issued the provider identifier in the PROV-IDENTIFIER data element. For (State Tax ID), if associated Provider Identifier Type (DE) value is equal to 6, then value must be the name of the state's taxation division. For (Other), if associated Provider Identifier Type (DE) value is equal to 8, then value must be the name of the entity that issued the identifier.\|	\|DE No\|Data Element Name\|Definition\| \|PRV078\|PROV-IDENTIFIER-ISSUING-ENTITY-ID\| A free text field to capture the identity of the entity that issued the provider identifier in the Provider Identifier (PRV.005.081) data element. For (State Tax ID), if associated Provider Identifier Type (PRV.005.077) value is equal to 6, then value must be the name of the state's taxation division. For (Other), if associated Provider Identifier Type (PRV.005.077) value is equal to 8, then value must be the name of the entity that issued the identifier.\|
06/24/2022	3.0.0	PROV-IDENTIFIER	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|PRV081\|PROV-IDENTIFIER\|A data element to capture the various ways used to distinguish providers from one another on claims and other interactions between providers and other entities. The specific type of identifier is defined in the corresponding value in the PROVIDER-IDENTIFIER-TYPE data element.\|	\|DE No\|Data Element Name\|Definition\| \|PRV081\|PROV-IDENTIFIER\|A data element to capture the various ways used to distinguish providers from one another on claims and other interactions between providers and other entities. The specific type of identifier is defined in the corresponding value in the Provider Identifier Type data element.\|
06/24/2022	3.0.0	BILLING-PROV-NPI-NUM	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CIP180\|BILLING-PROV-NPI-NUM\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\|	\|DE No\|Data Element Name\|Definition\| \|CIP180\|BILLING-PROV-NPI-NUM\|The National Provider ID (NPI) of the billing entity responsible for billing a patient for healthcare services. The billing provider can also be servicing, referring, or prescribing provider. Can be admitting provider except for Long Term Care.\|
06/24/2022	3.0.0	BILLING-PROV-NPI-NUM	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CLT131\|BILLING-PROV-NPI-NUM\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\|	\|DE No\|Data Element Name\|Definition\| \|CLT131\|BILLING-PROV-NPI-NUM\|The National Provider ID (NPI) of the billing entity responsible for billing a patient for healthcare services. The billing provider can also be servicing, referring, or prescribing provider. Can be admitting provider except for Long Term Care.\|
06/24/2022	3.0.0	BILLING-PROV-NPI-NUM	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|COT113\|BILLING-PROV-NPI-NUM\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\|	\|DE No\|Data Element Name\|Definition\| \|COT113\|BILLING-PROV-NPI-NUM\|The National Provider ID (NPI) of the billing entity responsible for billing a patient for healthcare services. The billing provider can also be servicing, referring, or prescribing provider. Can be admitting provider except for Long Term Care.\|
06/24/2022	3.0.0	BILLING-PROV-NPI-NUM	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CRX071\|BILLING-PROV-NPI-NUM\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\|	\|DE No\|Data Element Name\|Definition\| \|CRX071\|BILLING-PROV-NPI-NUM\|The National Provider ID (NPI) of the billing entity responsible for billing a patient for healthcare services. The billing provider can also be servicing, referring, or prescribing provider. Can be admitting provider except for Long Term Care.\|
06/24/2022	3.0.0	ADMITTING-PROV-NPI-NUM	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CLT174\|ADMITTING-PROV-NPI-NUM\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\|	\|DE No\|Data Element Name\|Definition\| \|CLT174\|ADMITTING-PROV-NPI-NUM\|The National Provider ID (NPI) of the doctor responsible for admitting a patient to a hospital or other inpatient health facility.\|
06/24/2022	3.0.0	ADMITTING-PROV-NPI-NUM	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CIP184\|ADMITTING-PROV-NPI-NUM\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\|	\|DE No\|Data Element Name\|Definition\| \|CIP184\|ADMITTING-PROV-NPI-NUM\|The National Provider ID (NPI) of the doctor responsible for admitting a patient to a hospital or other inpatient health facility.\|
06/24/2022	3.0.0	HEALTH-HOME-PROVIDER-NPI	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CIP221\|HEALTH-HOME-PROVIDER-NPI\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\| \|CLT167\|HEALTH-HOME-PROVIDER-NPI\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\| \|COT146\|HEALTH-HOME-PROVIDER-NPI\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\| \|CRX104\|HEALTH-HOME-PROVIDER-NPI\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\|	\|DE No\|Data Element Name\|Definition\| \|CIP221\|HEALTH-HOME-PROVIDER-NPI\|The National Provider ID (NPI) of the health home provider.\| \|CLT167\|HEALTH-HOME-PROVIDER-NPI\|The National Provider ID (NPI) of the health home provider.\| \|COT146\|HEALTH-HOME-PROVIDER-NPI\|The National Provider ID (NPI) of the health home provider.\| \|CRX104\|HEALTH-HOME-PROVIDER-NPI\|The National Provider ID (NPI) of the health home provider.\|
06/24/2022	3.0.0	REFERRING-PROV-NPI-NUM	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CIP190\|REFERRING-PROV-NPI-NUM\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\| \|CLT136\|REFERRING-PROV-NPI-NUM\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\| \|COT118\|REFERRING-PROV-NPI-NUM\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\|	\|DE No\|Data Element Name\|Definition\| \|CIP190\|REFERRING-PROV-NPI-NUM\|The National Provider ID (NPI) of the provider who recommended the servicing provider to the patient.\| \|CLT136\|REFERRING-PROV-NPI-NUM\|The National Provider ID (NPI) of the provider who recommended the servicing provider to the patient.\| \|COT118\|REFERRING-PROV-NPI-NUM\|The National Provider ID (NPI) of the provider who recommended the servicing provider to the patient.\|
06/24/2022	3.0.0	PRESCRIBING-PROV-NPI-NUM	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CRX075\|PRESCRIBING-PROV-NPI-NUM\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\|	\|DE No\|Data Element Name\|Definition\| \|CRX075\|PRESCRIBING-PROV-NPI-NUM\|The National Provider ID (NPI) of the provider who prescribed a medication to a patient.\|
06/24/2022	3.0.0	DISPENSING-PRESCRIPTION-DRUG-PROV-NPI	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CRX102\|DISPENSING-PRESCRIPTION-DRUG-PROV-NPI\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\|	\|DE No\|Data Element Name\|Definition\| \|CRX102\|DISPENSING-PRESCRIPTION-DRUG-PROV-NPI\|The National Provider ID (NPI) of the provider responsible for dispensing the prescription drug.\|
06/24/2022	3.0.0	SERVICING-PROV-NPI-NUM	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CLT213\|SERVICING-PROV-NPI-NUM\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\| \|COT190\|SERVICING-PROV-NPI-NUM\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\|	\|DE No\|Data Element Name\|Definition\| \|CLT213\|SERVICING-PROV-NPI-NUM\|The NPI of the health care professional who delivers or completes a particular medical service or non-surgical procedure. The Servicing Provider NPI Number is required when rendering provider is different than the attending provider and state or federal regulatory requirements call for a "combined claim" (i.e., a claim that includes both facility and professional components). Examples are Medicaid clinic bills or critical access hospital claims.\| \|COT190\|SERVICING-PROV-NPI-NUM\|The NPI of the health care professional who delivers or completes a particular medical service or non-surgical procedure. The Servicing Provider NPI Number is required when rendering provider is different than the attending provider and state or federal regulatory requirements call for a "combined claim" (i.e., a claim that includes both facility and professional components). Examples are Medicaid clinic bills or critical access hospital claims.\|
06/24/2022	3.0.0	OPERATING-PROV-NPI-NUM	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CIP265\|OPERATING-PROV-NPI-NUM\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\|	\|DE No\|Data Element Name\|Definition\| \|CIP265\|OPERATING-PROV-NPI-NUM\|The National Provider ID (NPI) of the provider who performed the surgical procedures on the beneficiary.\|
06/24/2022	3.0.0	ADMITTING-DIAGNOSIS-CODE	UPDATE	Data Dictionary	\|DE NO\|DATA ELEMENT NAME\| DEFINITION\| \|CIP030\|ADMITTING-DIAGNOSIS-CODE\|ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as "2105".\|	\|DE NO\|DATA ELEMENT NAME\| DEFINITION\| \|CIP030\|ADMITTING-DIAGNOSIS-CODE\|The ICD-9/10-CM Diagnosis Code provided at the time of admission by the physician. Since the Admitting Diagnosis is formulated before all tests and examinations are complete, it may be stated in the form of a problem or symptom and it may differ from any of the final diagnoses recorded in the medical record.\|
06/24/2022	3.0.0	ADMITTING-DIAGNOSIS-CODE	UPDATE	Data Dictionary	\|DE NO\|DATA ELEMENT NAME\| DEFINITION\| \|CLT027\|ADMITTING-DIAGNOSIS-CODE\|ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as "2105".\|	\|DE NO\|DATA ELEMENT NAME\| DEFINITION\| \|CLT027\|ADMITTING-DIAGNOSIS-CODE\|The ICD-9/10-CM Diagnosis Code provided at the time of admission by the physician. Since the Admitting Diagnosis is formulated before all tests and examinations are complete, it may be stated in the form of a problem or symptom and it may differ from any of the final diagnoses recorded in the medical record.\|
04/30/2021	3.0.0	RULE-7533	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '5', 'A', 'E' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and 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 and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-IP has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
04/30/2021	3.0.0	RULE-7534	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.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 one of the following: '1', '5', 'A', 'E' 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 TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT does not equal 0.00 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 has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-LT has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
04/30/2021	3.0.0	RULE-7535	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '2', '5', 'A', 'B', 'E' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT does not equal 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-OT has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
04/30/2021	3.0.0	RULE-7536	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '5', 'A', 'E' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT does not equal 0.00 and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-RX has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
04/09/2021	3.0.0	RULE-7435	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: '4', 'D', then (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is equal to 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.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is equal to 0.00)
04/09/2021	3.0.0	RULE-7436	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is equal to 0.00)'	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is equal to 0.00)'
04/09/2021	3.0.0	RULE-7437	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is equal to 0.00)'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is equal to 0.00)'
04/09/2021	3.0.0	RULE-7438	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is equal to 0.00)'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is equal to 0.00)'
06/24/2022	3.0.0	ELG045/ ENGL-PROF-CODE	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name ELG045\|PRIMARY-LANGUAGE-ENGL-PROF-CODE	DE No\|Data Element Name ELG045\|ENGL-PROF-CODE
04/30/2021	3.0.0	RULE-7384	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4'and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4'and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
04/30/2021	3.0.0	RULE-7385	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' '686'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'then CLAIM-LINE-RECORD-IP has a non-null value for XXI-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
04/30/2021	3.0.0	RULE-7387	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4'and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4'and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
04/30/2021	3.0.0	RULE-7388	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '4'and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '4'and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
04/30/2021	3.0.0	RULE-7389	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 one of the following: '4', 'D' 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 '02'then 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'and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' 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 '02'then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
04/30/2021	3.0.0	RULE-7390	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
04/30/2021	3.0.0	RULE-7391	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
05/21/2021	3.0.0	RULE-7474	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM then CLAIM-HEADER-RECORD-IP.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'	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.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM then CLAIM-HEADER-RECORD-IP.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'
05/21/2021	3.0.0	RULE-7475	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-IP.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'	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.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654','686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-IP.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'
05/21/2021	3.0.0	RULE-7476	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a non-null value for ADMITTING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-IP.ADMITTING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'	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.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP has a non-null value for ADMITTING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-IP.ADMITTING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'
05/21/2021	3.0.0	RULE-7477	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a non-null value for REFERRING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-IP.REFERRING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'	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.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP has a non-null value for REFERRING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-IP.REFERRING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'
05/21/2021	3.0.0	RULE-7478	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a non-null value for HEALTH-HOME-PROVIDER-NPI, then CLAIM-HEADER-RECORD-IP.HEALTH-HOME-PROVIDER-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'	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.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP has a non-null value for HEALTH-HOME-PROVIDER-NPI, then CLAIM-HEADER-RECORD-IP.HEALTH-HOME-PROVIDER-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'
05/21/2021	3.0.0	RULE-7479	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a non-null value for OPERATING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-IP.OPERATING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'	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.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP has a non-null value for OPERATING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-IP.OPERATING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'
05/21/2021	3.0.0	RULE-7482	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 has a non-null value for BILLING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-LT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'	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.ADJUSTMENT-IND does not equal '1' 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 has a non-null value for BILLING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-LT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'
05/21/2021	3.0.0	RULE-7483	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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-LT.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'	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.ADJUSTMENT-IND does not equal '1' 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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-LT.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'
05/21/2021	3.0.0	RULE-7484	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 has a non-null value for ADMITTING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-LT.ADMITTING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'	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.ADJUSTMENT-IND does not equal '1' 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 has a non-null value for ADMITTING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-LT.ADMITTING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'
05/21/2021	3.0.0	RULE-7485	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 has a non-null value for REFERRING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-LT.REFERRING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'	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.ADJUSTMENT-IND does not equal '1' 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 has a non-null value for REFERRING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-LT.REFERRING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'
05/21/2021	3.0.0	RULE-7489	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'
05/21/2021	3.0.0	RULE-7490	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-OT.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-OT.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'
05/21/2021	3.0.0	RULE-7491	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a non-null value for REFERRING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-OT.REFERRING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file.	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' , '686' and CLAIM-HEADER-RECORD-OT has a non-null value for REFERRING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-OT.REFERRING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file.
05/21/2021	3.0.0	RULE-7495	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-RX.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-RX.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'
05/21/2021	3.0.0	RULE-7496	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a non-null value for PRESCRIBING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-RX.PRESCRIBING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX has a non-null value for PRESCRIBING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-RX.PRESCRIBING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'
05/21/2021	3.0.0	RULE-7497	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI, then CLAIM-HEADER-RECORD-RX.DISPENSING-PRESCRIPTION-DRUG-PROV-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI, then CLAIM-HEADER-RECORD-RX.DISPENSING-PRESCRIPTION-DRUG-PROV-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'
05/21/2021	3.0.0	RULE-7498	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a non-null value for HEALTH-HOME-PROVIDER-NPI, then CLAIM-HEADER-RECORD-RX.HEALTH-HOME-PROVIDER-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX has a non-null value for HEALTH-HOME-PROVIDER-NPI, then CLAIM-HEADER-RECORD-RX.HEALTH-HOME-PROVIDER-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'
05/21/2021	3.0.0	RULE-7486	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 has a non-null value for HEALTH-HOME-PROVIDER-NPI, then CLAIM-HEADER-RECORD-LT.HEALTH-HOME-PROVIDER-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file	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.ADJUSTMENT-IND does not equal '1' 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 has a non-null value for HEALTH-HOME-PROVIDER-NPI, then CLAIM-HEADER-RECORD-LT.HEALTH-HOME-PROVIDER-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
05/21/2021	3.0.0	RULE-7492	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a non-null value for HEALTH-HOME-PROVIDER-NPI, then CLAIM-HEADER-RECORD-OT.HEALTH-HOME-PROVIDER-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a non-null value for HEALTH-HOME-PROVIDER-NPI, then CLAIM-HEADER-RECORD-OT.HEALTH-HOME-PROVIDER-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
05/21/2021	3.0.0	RULE-7494	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a non-null value for UNDER-SUPERVISION-OF-PROV-NPI, then CLAIM-HEADER-RECORD-OT.UNDER-SUPERVISION-OF-PROV-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a non-null value for UNDER-SUPERVISION-OF-PROV-NPI, then CLAIM-HEADER-RECORD-OT.UNDER-SUPERVISION-OF-PROV-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
05/21/2021	3.0.0	RULE-7507	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM, and CLAIM-HEADER-RECORD-IP.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file then the "Entity Type Code" is equal to '2' in the NPPES data file	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.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM, and CLAIM-HEADER-RECORD-IP.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file then the "Entity Type Code" is equal to '2' in the NPPES data file
05/21/2021	3.0.0	RULE-7508	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 has a non-null value for BILLING-PROV-NPI-NUM, and CLAIM-HEADER-RECORD-LT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file then the "Entity Type Code" is equal to '2' in the NPPES data file	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.ADJUSTMENT-IND does not equal '1' 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 has a non-null value for BILLING-PROV-NPI-NUM, and CLAIM-HEADER-RECORD-LT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file then the "Entity Type Code" is equal to '2' in the NPPES data file
05/21/2021	3.0.0	RULE-7509	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM, and CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file then the "Entity Type Code" is equal to '2' or '1' in the NPPES data file	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM, and CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file then the "Entity Type Code" is equal to '2' or '1' in the NPPES data file
05/21/2021	3.0.0	RULE-7510	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM, and CLAIM-HEADER-RECORD-RX.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file then the "Entity Type Code" is equal to '2' in the NPPES data file	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM, and CLAIM-HEADER-RECORD-RX.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file then the "Entity Type Code" is equal to '2' in the NPPES data file
05/21/2021	3.0.0	RULE-7511	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a non-null value for PRESCRIBING-PROV-NPI-NUM, and CLAIM-HEADER-RECORD-RX.PRESCRIBING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file then the "Entity Type Code" is equal to '1' in the NPPES data file	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX has a non-null value for PRESCRIBING-PROV-NPI-NUM, and CLAIM-HEADER-RECORD-RX.PRESCRIBING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file then the "Entity Type Code" is equal to '1' in the NPPES data file
05/21/2021	3.0.0	RULE-7512	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI, and CLAIM-HEADER-RECORD-RX.DISPENSING-PRESCRIPTION-DRUG-PROV-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file then the "Entity Type Code" is equal to '1' in the NPPES data file	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI, and CLAIM-HEADER-RECORD-RX.DISPENSING-PRESCRIPTION-DRUG-PROV-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file then the "Entity Type Code" is equal to '1' in the NPPES data file
06/24/2022	3.0.0	DISABILITY-TYPE-CODE	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG224 \|DISABILITY-TYPE-CODE \|Obsolete \| 1.(LV) value must be in Disability Type Code List (VVL) 2.(S) value must be 2 characters 3.(N) conditional	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG224 \|DISABILITY-TYPE-CODE \| A code to identify disability status in accordance with requirements of Section 4302 of the Affordable Care Act.\| 1.(LV) value must be in Disability Type Code List (VVL) 2.(S) value must be 2 characters 3.(N) mandatory
06/24/2022	3.0.0	AFFILIATED-PROGRAM-TYPE	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|PRV119\|AFFILIATED-PROGRAM-TYPE\| A code to identify the category of program that the provider is affiliated. see Affiliated Program Type List (VVL.004) (health plan federal assigned) if associated Affiliated Program Type (DE) value is 1, then value must be the federal-assigned plan ID of the health plan in which a provider is enrolled to provide services. (health plan state assigned) if associated Affiliated Program Type (DE) value is 2, then value must be the state-assigned plan ID of the health plan in which a provider is enrolled to provide services. (waiver) if associated Affiliated Program Type (DE) value is 3, then value must be the core Federal Waiver ID in which a provider is allowed to deliver services to eligible beneficiaries. (health home entity) if associated Affiliated Program Type (DE) value is 4, then value must be the name of a health home in which a provider is participating. (other) if associated Affiliated Program Type (DE) value is 5, then value must be an identifier for something other than a health plan, waiver, or health home entity.\|	\|DE No\|Data Element Name\|Definition\| \|PRV119\|AFFILIATED-PROGRAM-TYPE\|A code to identify the category of program that the provider is affiliated.\|
06/24/2022	3.0.0	AFFILIATED-PROGRAM-ID	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|PRV120\|AFFILIATED-PROGRAM-ID A data element to identify the Medicaid/CHIP programs, waivers and demonstrations in which the provider participates. (health plan federal assigned) if associated Affiliated Program Type (DE) value is 1, then value must be the federal-assigned plan ID of the health plan in which a provider is enrolled to provide services. (health plan state assigned) if associated Affiliated Program Type (DE) value is 2, then value must be the state-assigned plan ID of the health plan in which a provider is enrolled to provide services. (waiver) if associated Affiliated Program Type (DE) value is 3, then value must be the core Federal Waiver ID in which a provider is allowed to deliver services to eligible beneficiaries. (health home entity) if associated Affiliated Program Type (DE) value is 4, then value must be the name of a health home in which a provider is participating. (other) if associated Affiliated Program Type (DE) value is 5, then value must be an identifier for something other than a health plan, waiver, or health home entity.	\|DE No\|Data Element Name\|Definition\| \|PRV120\|AFFILIATED-PROGRAM-ID A data element to identify the Medicaid/CHIP programs, waivers and demonstrations in which the provider participates. If Affiliated Program Type = 2 (Health Plan State-assigned health plan ID), then the value in Affiliated Program ID is the state-assigned plan ID of the health plan in which a provider is enrolled to provide services. If Affiliated Program Type = 3 (Waiver), then the value in Affiliated Program ID is the core Federal Waiver ID in which a provider is allowed to deliver services to eligible beneficiaries. If Affiliated Program Type = 4 (Health Home Entity), then the value in Affiliated Program ID is the name of a health home in which a provider is participating. If Affiliated Program Type = 5 (Other), then the value in Affiliated Program ID is an identifier for something other than a health plan, waiver, or health home entity.
06/24/2022	3.0.0	COVERAGE-TYPE	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME DEFINITION\| \|TPL058\|COVERAGE-TYPE\|This code identifies the relationship of the policy holder to the Medicaid/CHIP beneficiary. see Policy Owner Code List (VVL.099)\|	\|DE NO\| DATA ELEMENT NAME\|DEFINITION\| \|TPL058\|COVERAGE-TYPE \|Code indicating the level of coverage being provided under this policy for the insured by the TPL carrier.\|
06/24/2022	3.0.0	DRG-DESCRIPTION	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CIP029\|DRG-DESCRIPTION\|Description of the associated state-specific DRG code. If using standard MS-DRG classification system, a DRG Description is not required.\|	\|DE No\|Data Element Name\|Definition\| \|CIP029\|DRG-DESCRIPTION\|Description of the associated state-specific DRG code. If using standard MS-DRG classification system, leave blank.\|
06/24/2022	3.0.0	DIAGNOSIS-RELATED-GROUP-IND	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CIP069\|DIAGNOSIS-RELATED-GROUP-IND\|An indicator identifying the grouping algorithm used to assign Diagnosis Related Group (DRG) values.\|	\|DE No\|Data Element Name\|Definition\| \|CIP069\|DIAGNOSIS-RELATED-GROUP-IND\|An indicator identifying the grouping algorithm used to assign Diagnosis Related Group (DRG) values.Values are generated by combining two types of information: Position 1-2, State/Group generating DRG: If state specific system, fill with two digit US postal code representation for state. If CMS Grouper, fill with 'HG'. If any other system, fill with 'XX'. Position 3-4, fill with the number that represents the DRG version used (01-98). For example, 'HG15" would represent CMS Grouper version 15. If version is unknown, fill with '99".\|
06/24/2022	3.0.0	DRG-OUTLIER-AMT	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| CODING REQUIREMENT CIP194 \|DRG-OUTLIER-AMT\|The additional payment on a claim that is associated with either a cost outlier or length of stay outlier.Outlier payments compensate hospitals paid on a fixed amount per Medicare "diagnosis related group" discharge with extra dollars for patient stays that substantially exceed the typical requirements for patient stays in the same DRG category. \|1.(GS) value must satisfy the requirements of US Dollar Amount (DT) 2.(N) conditional 3.(FD1) value must not be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'	\|DE No\|Data Element Name\|Definition\| CODING REQUIREMENT CIP194 \|DRG-OUTLIER-AMT\|The additional payment on a claim that is associated with either a cost outlier or length of stay outlier.Outlier payments compensate hospitals paid on a fixed amount per Medicare "diagnosis related group" discharge with extra dollars for patient stays that substantially exceed the typical requirements for patient stays in the same DRG category \|1.(GS) value must satisfy the requirements of US Dollar Amount (DT) 2.(FD1) value must not be populated, if Outlier Code (CIP.002.197) equals '00' or '09' 3.(N) conditional
06/24/2022	3.0.0	OUTLIER-CODE	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| \|CIP197\|OUTLIER-CODE\| This code indicates the Type of Outlier Code or DRG Source. The field identifies two mutually exclusive conditions. The first, for PPS providers(codes 0, 1, and 2), classifies stays of exceptional cost or length (outliers). The second, for non-PPS providers (codes 6, 7, 8, and 9), denotes the source for developing the DRG. https://www.resdac.org/cms-data/variables/medpar-drgoutlier-stay-code 1.(LV) value must be in Outlier Code List (VVL) 2.(FD1) (Day Outlier) If Outlier Code is 01, then Outlier Days (CIP.002.198) must be populated. 3.(S) value must be 2 characters 4.(N) conditional 5.(FD1) if value equals '00' or '09', then DRG Outlier Amount (CIP.002.194) must not be populated\|	\|DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| \|CIP197\|OUTLIER-CODE\| This code indicates the Type of Outlier Code or DRG Source. The field identifies two mutually exclusive conditions. The first, for PPS providers (codes 0, 1, and 2), classifies stays of exceptional cost or length (outliers). The second, for non-PPS providers (codes 6, 7, 8, and 9), denotes thesource for developing the DRG. https://www.resdac.org/cms-data/variables/medpar-drgoutlier-stay-code 1.(LV) value must be in Outlier Code List (VVL) 2.(S) value must be 2 characters 3.(FD1) value is mandatory if either DRG Outlier Amount (CIP.002.194) or Outlier Days (CIP.002.198) are populated 4.(N) conditional\|
06/24/2022	3.0.0	ORIGINATION-ADDR-LN2	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| \|COT200\|ORIGINATION-ADDR-LN2\|The street address of the origination point from which a patient is transported either from home or Long term care facility to a health care provider for healthcare services or vice versa. For transportation claims, this is only required if state has captured this information, otherwise it is conditional.\|	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| \|COT200\|ORIGINATION-ADDR-LN2\|The second line of the street address of the destination point to which a patient is transported either from home or Long term care facility to a health care provider for healthcare services or vice versa. For transportation claims, this is only required if state has captured this information, otherwise it is conditional.\|
06/24/2022	3.0.0	ORIGINATION-STATE	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| \|COT202\|ORIGINATION-STATE\|The ANSI numeric code of the origination state in which a patient is transported either from home or a long term care facility to a healthcare provider to a health care provider for healthcare services or vice versa.\| 1.Value must be in State Code List (VVL) 2. Value must be 2 characters 3. conditional 4. (transportation claim) value is mandatory and must be provided for all transportation claims\|	\|DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| \|COT202\|ORIGINATION-STATE\|The ANSI numeric code of the origination state in which a patient is transported either from home or a long term care facility to a health care provider to a health care provider for healthcare services or vice versa.\| 1.Value must be in State Code List (VVL) 2. Value must be 2 characters 3.(N) conditional\|
06/24/2022	3.0.0	DESTINATION-STATE	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| COT207\|DESTINATION-STATE \|The ANSI state numeric code for the U.S. state, Territory, or the District of Columbia code of the destination state in which a patient is transported either from home or a long term care facility to a health care provider for healthcare services or vice versa.\| 1.(GS) value must satisfy the requirements of Address State (CE) 2.(FD1) (transportation claim) value is mandatory and must be provided for all transportation claims 3.(N) conditional\|	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| COT207\|DESTINATION-STATE\|The ANSI state numeric code for the U.S. state, Territory, or the District of Columbia code of the destination state in which a patient is transported either from home or a long term care facility to a health care provider for healthcare services or vice versa.\| 1.(GS) value must satisfy the requirements of Address State (CE)\|
06/24/2022	3.0.0	DESTINATION-ZIP-CODE	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| \|COT208\|DESTINATION-ZIP-CODE\|Description: U.S. ZIP Code component of an address associated with a given entity (e.g. person, organization, agency, etc.)\|	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| \|COT208\|DESTINATION-ZIP-CODE\|The zip code of the destination city to which a patient is transported either from home or long term care facility to a health care provider for healthcare services or vice versa. For transportation claims only. Required if state has captured this information, otherwise it is conditional.\|
06/24/2022	3.0.0	DRUG-UTILIZATION-CODE	UPDATE	Data Dictionary	DE No\|Data Element Name\|CODING REQUIREMENT\| CRX143\|DRUG-UTILIZATION-CODE\| 1.(S) value must be 6 characters or less 2.(S) characters 1 and 2 (2-character string) may be in Drug Utilization Result of Service Code List (VVL), or spaces in cases where code is unused or not available 3.(S) characters 3 and 4 (2-character string) may be in Drug Utilization Professional Service Code List (VVL), or spaces in cases where code is unused or not available 4.(S) characters 5 and 6 (2-character string) may be in Drug Utilization Reason For Service Code List (VVL), or not populated in cases where code is unused or not available 5.(N) mandatory\|	DE No\|Data Element Name\|CODING REQUIREMENT\| CRX143\|DRUG-UTILIZATION-CODE\| 1.(S) value must be 6 characters or less 2.(S) characters 1 and 2 (2-character string) must be in Drug Utilization Reason of Service Code List (VVL) 3.(S) characters 3 and 4 (2-character string) must be in Drug Utilization Professional Service Code List (VVL) 4.(S) characters 5 and 6 (2-character string) must be in Drug Utilization Result For Service Code List (VVL) 5.(N) mandatory\|
07/23/2021	3.0.0	TOT-COPAY-AMT (CIP.002.115)	UPDATE	Data Dictionary	"If associated Crossover Indicator value is '0' (not a crossover claim), then value should not be populated." AND "(Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in ["01", "02", "03", "04", "05", "06", "08", "09", or "10"], then value is mandatory and must be provided"	N/A
05/21/2021	3.0.0	RULE-1854	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
05/21/2021	3.0.0	RULE-898	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then The values of the following fields should be unique for each CLAIM-HEADER-RECORD-LT record: DIAGNOSIS-CODE-1, DIAGNOSIS-CODE-2, DIAGNOSIS-CODE-3, DIAGNOSIS-CODE-4, DIAGNOSIS-CODE-5'	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.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' then the values of the following fields should be unique for each CLAIM-HEADER-RECORD-LT record: DIAGNOSIS-CODE-1, DIAGNOSIS-CODE-2, DIAGNOSIS-CODE-3, DIAGNOSIS-CODE-4, DIAGNOSIS-CODE-5'
05/21/2021	3.0.0	RULE-451	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-4, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 is a valid value specified by CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 or is a state valid value from 'PROCEDURE-CODE-STATE'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 is '01', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 should be a valid value in 'CPT'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 is '02', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 should be a valid value in 'ICD-9-PROCEDURE-CODE'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 is '06', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 should be a valid value in 'HCPCS'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 is '07', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 should be a valid value in 'ICD-10-PROCEDURE-CODE'.'	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.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-4, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 is a valid value specified by CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 or is a state valid value from 'PROCEDURE-CODE-STATE'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 is '01', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 should be a valid value in 'CPT'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 is '02', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 should be a valid value in 'ICD-9-PROCEDURE-CODE'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 is '06', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 should be a valid value in 'HCPCS'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 is '07', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 should be a valid value in 'ICD-10-PROCEDURE-CODE'.'
05/21/2021	3.0.0	RULE-465	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-5, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 is a valid value specified by CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 or is a state valid value from 'PROCEDURE-CODE-STATE'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 is '01', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 should be a valid value in 'CPT'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 is '02', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 should be a valid value in 'ICD-9-PROCEDURE-CODE'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 is '06', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 should be a valid value in 'HCPCS'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 is '07', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 should be a valid value in 'ICD-10-PROCEDURE-CODE'.'	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.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-5, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 is a valid value specified by CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 or is a state valid value from 'PROCEDURE-CODE-STATE'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 is '01', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 should be a valid value in 'CPT'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 is '02', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 should be a valid value in 'ICD-9-PROCEDURE-CODE'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 is '06', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 should be a valid value in 'HCPCS'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 is '07', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 should be a valid value in 'ICD-10-PROCEDURE-CODE'.'
05/21/2021	3.0.0	RULE-521	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then The values of the following fields should be unique for each CLAIM-HEADER-RECORD-IP record: CLAIM-PYMT-REM-CODE-1, CLAIM-PYMT-REM-CODE-2, CLAIM-PYMT-REM-CODE-3, CLAIM-PYMT-REM-CODE-4'	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.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' then The values of the following fields should be unique for each CLAIM-HEADER-RECORD-IP record: CLAIM-PYMT-REM-CODE-1, CLAIM-PYMT-REM-CODE-2, CLAIM-PYMT-REM-CODE-3, CLAIM-PYMT-REM-CODE-4'
05/21/2021	3.0.0	RULE-1343	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DIAGNOSIS-CODE-1, then when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-1 is '1', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-1 should be a valid value in 'ICD-9-DIAGNOSIS-CODE'. when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-1 is '2', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-1 should be a valid value in 'ICD-10-DIAGNOSIS-CODE'.'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DIAGNOSIS-CODE-1, then when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-1 is '1', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-1 should be a valid value in 'ICD-9-DIAGNOSIS-CODE'.
05/21/2021	3.0.0	RULE-1347	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DIAGNOSIS-CODE-2, then when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-2 is '1', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-2 should be a valid value in 'ICD-9-DIAGNOSIS-CODE'. when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-2 is '2', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-2 should be a valid value in 'ICD-10-DIAGNOSIS-CODE'.'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DIAGNOSIS-CODE-2, then when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-2 is '1', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-2 should be a valid value in 'ICD-9-DIAGNOSIS-CODE'. when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-2 is '2', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-2 should be a valid value in 'ICD-10-DIAGNOSIS-CODE'.'
05/21/2021	3.0.0	RULE-1349	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DIAGNOSIS-CODE-2, then CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-1 does not equal CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-2'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DIAGNOSIS-CODE-2, then CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-1 does not equal CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-2'
05/21/2021	3.0.0	RULE-1371	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-OT.TYPE-OF-BILL is a valid type of bill code'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-OT.TYPE-OF-BILL is a valid type of bill code'
05/21/2021	3.0.0	RULE-1379	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then The values of the following fields should be unique for each CLAIM-HEADER-RECORD-OT record: CLAIM-PYMT-REM-CODE-1, CLAIM-PYMT-REM-CODE-2, CLAIM-PYMT-REM-CODE-3, CLAIM-PYMT-REM-CODE-4'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' then the values of the following fields should be unique for each CLAIM-HEADER-RECORD-OT record: CLAIM-PYMT-REM-CODE-1, CLAIM-PYMT-REM-CODE-2, CLAIM-PYMT-REM-CODE-3, CLAIM-PYMT-REM-CODE-4'
05/21/2021	3.0.0	RULE-1433	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
05/21/2021	3.0.0	RULE-1544	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W', then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NPI-NUM then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2'
05/21/2021	3.0.0	RULE-1558	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT has a null or invalid value for MEDICARE-BENEFICIARY-IDENTIFIER, then CLAIM-HEADER-RECORD-OT has a valid, non-null value for MEDICARE-HIC-NUM'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT has a null or invalid value for MEDICARE-BENEFICIARY-IDENTIFIER, then CLAIM-HEADER-RECORD-OT has a valid, non-null value for MEDICARE-HIC-NUM'
05/21/2021	3.0.0	RULE-1623	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE , then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE'
05/21/2021	3.0.0	RULE-1630	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE'
05/21/2021	3.0.0	RULE-1632	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and FILE-HEADER-RECORD-OT has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to FILE-HEADER-RECORD-OT.END-OF-TIME-PERIOD'	if and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and FILE-HEADER-RECORD-OT has a valid, non-null value for END-OF-TIME-PERIOD then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to FILE-HEADER-RECORD-OT.END-OF-TIME-PERIOD'
05/21/2021	3.0.0	RULE-1634	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for PROCEDURE-CODE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.PROCEDURE-CODE is a valid value specified by CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG or is a state valid value from 'PROCEDURE-CODE-STATE'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '01', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'CPT'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '02', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'ICD-9-PROCEDURE-CODE'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '06', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'HCPCS'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '07', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'ICD-10-PROCEDURE-CODE'.'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT has a valid, non-null value for PROCEDURE-CODE then CLAIM-LINE-RECORD-OT.PROCEDURE-CODE is a valid value specified by CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG or is a state valid value from 'PROCEDURE-CODE-STATE'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '01', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'CPT'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '02', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'ICD-9-PROCEDURE-CODE'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '06', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'HCPCS'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '07', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'ICD-10-PROCEDURE-CODE'.'
05/21/2021	3.0.0	RULE-1642	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' then if the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
05/21/2021	3.0.0	RULE-1665	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-OT.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-OT.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
05/21/2021	3.0.0	RULE-1668	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NPI-NUM then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2'
05/21/2021	3.0.0	RULE-1675	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-NUM' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-NUM' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
05/21/2021	3.0.0	RULE-1677	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-SURFACE-CODE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-SURFACE-CODE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
05/21/2021	3.0.0	RULE-2758	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DATE-OF-BIRTH and the first character of CLAIM-LINE-RECORD-OT.TOOTH-NUM is one of 'A' through 'T', then the difference between dates CLAIM-HEADER-RECORD-OT.DATE-OF-BIRTH and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is less than 15 years'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DATE-OF-BIRTH and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and the first character of CLAIM-LINE-RECORD-OT.TOOTH-NUM is one of 'A' through 'T', then the difference between dates CLAIM-HEADER-RECORD-OT.DATE-OF-BIRTH and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is less than 15 years'
05/21/2021	3.0.0	BILLING-PROV-NUM (COT.002.112)	UPDATE	Data Dictionary	When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID or When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type = '1'	N/A
06/11/2021	3.0.0	RULE-7537	ADD	Data Dictionary - Validation Rules	N/A	if RACE-INFORMATION.RACE is not equal to one of the following: '010', '015', then RACE-INFORMATION has a null value for RACE-OTHER'
07/02/2021	3.0.0	RULE-7529	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '2', and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) and (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE) and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.IMMIGRATION-STATUS is equal to one of the following: '1', '2', '3'
06/11/2021	3.0.0	TOT-BILLED-AMT	UPDATE	Data Dictionary	"If associated Type of Claim value is 2, 4, 5, B, D, or E, then value should not be populated"	N/A
06/11/2021	3.0.0	ELG.016.214	ADD	Data Dictionary	N/A	If associated Race (ELG.016.213) value is not in [ "010", "015" ], then value must be null.
06/24/2022	3.0.0	COT145/ CAPITATED-PAYMENT-AMT-REQUESTED	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT145\|CAPITATED-PAYMENT-AMT-REQUESTED\|S9(11)V99\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002	N/A
06/24/2022	3.0.0	COT144/ DATE-CAPITATED-AMOUNT-REQUESTED	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT144\|DATE-CAPITATED-AMOUNT-REQUESTED\|9(8)\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002	N/A
07/02/2021	3.0.0	RULE-7538	ADD	Data Dictionary - Validation Rules	N/A	if ENROLLMENT-TIME-SPAN has a non-null value for MSIS-IDENTIFICATION-NUM then for every record of type ENROLLMENT-TIME-SPAN, there must be a valid record of type PRIMARY-DEMOGRAPHICS that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) and ENROLLMENT-TIME-SPAN.ENROLLMENT-EFF-DATE is greater than or equal to PRIMARY-DEMOGRAPHICS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN.ENROLLMENT-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE
07/02/2021	3.0.0	RULE-7539	ADD	Data Dictionary - Validation Rules	N/A	if ENROLLMENT-TIME-SPAN has a non-null value for MSIS-IDENTIFICATION-NUM then for every record of type ENROLLMENT-TIME-SPAN, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) and (ENROLLMENT-TIME-SPAN.ENROLLMENT-EFF-DATE is greater than or equal to VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN.ENROLLMENT-END-DATE is less than or equal to VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE)
07/02/2021	3.0.0	RULE-7540	ADD	Data Dictionary - Validation Rules	N/A	if ENROLLMENT-TIME-SPAN has a non-null value for MSIS-IDENTIFICATION-NUM then for every record of type ENROLLMENT-TIME-SPAN, there must be a valid record of type ELIGIBLITY-DETERMINANTS that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-Num) and ELIGIBLITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' and (ENROLLMENT-TIME-SPAN.ENROLLMENT-EFF-DATE >= ELIGIBLITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and ENROLLMENT-TIME-SPAN.ENROLLMENT-END-DATE <= ELIGIBLITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)
06/11/2021	3.0.0	RULE-7452	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.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT'	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 '0' or '4' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR is equal to '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' then (CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00')
06/11/2021	3.0.0	RULE-7453	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT'	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR is equal to '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' then (CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00')
06/11/2021	3.0.0	RULE-7454	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then (CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00')
06/11/2021	3.0.0	RULE-7455	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then CLAIM-LINE-RECORD-RX has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR is equal to '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C' then (CLAIM-LINE-RECORD-RX has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00')
07/15/2022	3.0.1	RULE-7550	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.1115A-DEMONSTRATION-IND equals '1', then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type 1115A-DEMONSTRATION-INFORMATION that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is greater than or equal to 1115A-DEMONSTRATION-INFORMATION.1115A-EFF-DATE and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is less than or equal to 1115A-DEMONSTRATION-INFORMATION.1115A-END-DATE and 1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equals '1'
07/15/2022	3.0.1	RULE-7551	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' and CLAIM-HEADER-RECORD-LT.1115A-DEMONSTRATION-IND equals '1', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type 1115A-DEMONSTRATION-INFORMATION that matches on the join keys and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE is greater than or equal to 1115A-DEMONSTRATION-INFORMATION.1115A-EFF-DATE and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE is less than or equal to 1115A-DEMONSTRATION-INFORMATION.1115A-END-DATE and 1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equals '1'
07/15/2022	3.0.1	RULE-7552	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.1115A-DEMONSTRATION-IND equals '1' , then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type 1115A-DEMONSTRATION-INFORMATION that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE is greater than or equal to 1115A-DEMONSTRATION-INFORMATION.1115A-EFF-DATE and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to 1115A-DEMONSTRATION-INFORMATION.1115A-END-DATE and 1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equals '1'
07/15/2022	3.0.1	RULE-7549	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.1115A-DEMONSTRATION-IND equals '1' , then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type 1115A-DEMONSTRATION-INFORMATION that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is greater than or equal to 1115A-DEMONSTRATION-INFORMATION.1115A-EFF-DATE and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is less than or equal to 1115A-DEMONSTRATION-INFORMATION.1115A-END-DATE and 1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equals '1'
07/23/2021	3.0.0	RULE-7541	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is equal to '686' then CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '1'
07/23/2021	3.0.0	RULE-7542	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is equal to '686' then CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '1'
07/23/2021	3.0.0	RULE-7543	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is equal to '686' then CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '1'
07/23/2021	3.0.0	RULE-7544	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is equal to '686' then CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '1'
06/24/2022	3.0.0	ELG215/AMERICAN-INDIAN-ALASKA-NATIVE-INDICATOR	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name ELG215\|CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR	DE No\|Data Element Name ELG215\|AMERICAN-INDIAN-ALASKA-NATIVE-INDICATOR
07/02/2021	3.0.0	AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR (ELG215)	UPDATE	Data Dictionary - Valid Values	Valid Value '0' Description: Individual does not meet the definition of an American Indian/Alaskan Native. Valid Value '1' Description: Individual meets the definition of an American Indian/Alaskan Native.	Valid Value '0' Description: Individual does not meet the definition of an American Indian/Alaska Native. Valid Value '1' Description: Individual meets the definition of an American Indian/Alaska Native.
07/02/2021	3.0.0	RACE (ELG213)	UPDATE	Data Dictionary - Valid Values	Valid Value '003' Description: American Indian or Alaskan Native	Valid Value '003' Description: American Indian or Alaska Native
06/11/2021	3.0.0	RULE-7459	UPDATE	Data Dictionary - Validation Rules	if WAIVER-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM and WAIVER-TYPE is equal to one of the following: '02', '03', '04', '05', '06', '07', '08','09', '10', '11, '12', '13', '14', '15', '16', '17', '18','19', '20', '32', '33' then substr(WAIVER-PARTICIPATION.WAIVER-ID, 1, 2) must be in (A-Z/a-z) and substr(WAIVER-PARTICIPATION.WAIVER-ID, 3, 1) must be equal to '.' and substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 7) must be equal to 0-9 digits)	if WAIVER-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM and WAIVER-TYPE is equal to one of the following: '02', '03', '04', '05', '06', '07', '08','09', '10', '11, '12', '13', '14', '15', '16', '17', '18','19', '20', '32', '33' then substr(WAIVER-PARTICIPATION.WAIVER-ID, 1, 2) must be in (A-Z/a-z) and substr(WAIVER-PARTICIPATION.WAIVER-ID, 3, 1) must be equal to '.' and substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 4) must be equal to 0-9 digits)
06/24/2022	3.0.0	ELG-IDENTIFIER-ISSUING-ENTITY-ID	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| ELG262\|ELG-IDENTIFIER-ISSUING-ENTITY-ID\|This data element is reserved for future use.\| 1.(S) value must be 18 characters or less 2.(N) optional\|	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| ELG262\|ELG-IDENTIFIER-ISSUING-ENTITY-ID\|This data element is reserved for future use\| 1.(S) value must be 18 characters or less\|
07/02/2021	3.0.0	RULE-7384	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
07/02/2021	3.0.0	RULE-7385	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02' then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE	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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02' then CLAIM-LINE-RECORD-IP has a non-null value for XXI-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
07/02/2021	3.0.0	RULE-7387	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
07/02/2021	3.0.0	RULE-7388	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '4' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
07/02/2021	3.0.0	RULE-7389	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 one of the following: '4', 'D' 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 '02' then 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 one of the following: '4', 'D' 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 '02' then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
07/02/2021	3.0.0	RULE-7390	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02' then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02' then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
07/02/2021	3.0.0	RULE-7391	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02' then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE
07/02/2021	3.0.0	RULE-7191	UPDATE	Data Dictionary - Validation Rules	if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '1', then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys and (ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE), where VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '1', '2'	if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '1', then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE), where VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '1', '2'
07/02/2021	3.0.0	RULE-7192	UPDATE	Data Dictionary - Validation Rules	if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '2', then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys and (ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE), where VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '3'	if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '2', then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE), where VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '3'
07/23/2021	3.0.0	TOT-BILLED-AMT (CIP.002.112)	UPDATE	Data Dictionary	“If associated Type of Claim value is 2, 4, 5, B, D, or E, then value should not be populated"	N/A
07/23/2021	3.0.0	RULE-7278	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.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND equals '0', then CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-IP.MEDICAID-PAID-AMT values', where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'	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.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND equals '0', and CLAIM-HEADER-RECORD-IP.PAYMENT-LEVEL-IND equals '2', then CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-IP.MEDICAID-PAID-AMT values' where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
07/23/2021	3.0.0	RULE-7279	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND equals '0', then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT values', where CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND equals '0', and CLAIM-HEADER-RECORD-LT.PAYMENT-LEVEL-IND equals '2', then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT values' where CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
07/23/2021	3.0.0	RULE-7280	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0', then CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT values', where CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0', and CLAIM-HEADER-RECORD-OT.PAYMENT-LEVEL-IND equals '2', then CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT values' where CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
07/23/2021	3.0.0	RULE-7281	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0', then CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-RX.MEDICAID-PAID-AMT values', where CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0', and CLAIM-HEADER-RECORD-RX.PAYMENT-LEVEL-IND equals '2', then CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-RX.MEDICAID-PAID-AMT values' where CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
08/13/2021	3.0.0	TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|00010101\|99991231\|1\|Rural Health Clinic (RHC)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|00010101\|99991231\|2\|Hospital Based or Independent Renal Dialysis Facility\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|00010101\|99991231\|3\|Free Standing Provider-Based Federally Qualified Health Center (FQHC)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|00010101\|99991231\|4\|Other Rehabilitation Facility (ORF)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|00010101\|99991231\|5\|Comprehensive Outpatient Rehabilitation Facility (CORF)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|00010101\|99991231\|6\|Community Mental Health Center (CMHC)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|20100401\|99991231\|7\|Federally Qualified Health Center (FQHC) (Effective 4/1/10)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|20120401\|99991231\|8\|Licensed Freestanding Emergency Medical Facility (Effective 4/1/12)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|00010101\|99991231\|9\|OTHER\|
08/13/2021	3.0.0	TYPE-OF-BILL-2-FACILITY-TYPE	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|99991231\|1\|Hospital\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|99991231\|2\|Skilled Nursing\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|99991231\|3\|Home Health\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|99991231\|4\|Religious Nonmedical (Hospital)\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|20051001\|5\|Reserved for national assignment (discontinued effective 10/1/05).\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|99991231\|6\|Intermediate Care\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|99991231\|7\|Clinic or Hospital Based Renal Dialysis Facility (requires special information in second digit below).\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|99991231\|8\|Special facility or hospital ASC surgery (requires special information in second digit below).\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|99991231\|9\|Reserved for National Assignment\|
08/13/2021	3.0.0	TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|99991231\|1\|Inpatient\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|99991231\|2\|Inpatient\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|99991231\|3\|Outpatient\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|99991231\|4\|Other\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|99991231\|5\|Intermediate Care - Level I\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|99991231\|6\|Intermediate Care - Level II\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|20051001\|7\|Reserved for national assignment (discontinued effective 10/1/05).\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|99991231\|8\|Swing Bed (may be used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement).\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|99991231\|9\|Reserved for National Assignment\|
08/13/2021	3.0.0	TYPE-OF-BILL-4-FREQUENCY	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|0\|Nonpayment/Zero Claims\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|1\|Admit Through Discharge Claim\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|2\|Interim-First Claim\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|3\|Interim-Continuing Claims (Not valid for PPS Bills)\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|A\|Admission/Election Notice\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|B\|Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care Institution Termination/Revocation Notice\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|C\|Hospice Change of Provider Notice\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|D\|Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care Institution Void/Cancel\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|E\|Hospice Change of Ownership\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|F\|Beneficiary Initiated Adjustment Claim\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|G\|CWF Initiated Adjustment Claim\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|H\|CMS Initiated Adjustment Claim\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|I\|FI Adjustment Claim (Other than QIO or Provider\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|J\|Initiated Adjustment Claim-Other\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|K\|OIG Initiated Adjustment Claim\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|M\|MSP Initiated Adjustment Claim\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|P\|QIO Adjustment Claim\|
07/23/2021	3.0.0	RULE-7545	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is equal to '686' then CLAIM-LINE-RECORD-IP.LINE-ADJUSTMENT-IND is equal to '1'
07/23/2021	3.0.0	RULE-7546	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is equal to '686' then CLAIM-LINE-RECORD-LT.LINE-ADJUSTMENT-IND is equal to '1'
07/23/2021	3.0.0	RULE-7547	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is equal to '686' then CLAIM-LINE-RECORD-OT.LINE-ADJUSTMENT-IND is equal to '1'
07/23/2021	3.0.0	RULE-7548	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is equal to '686' then CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-IND is equal to '1'
08/13/2021	3.0.0	MEDICAID-PAID-AMT	UPDATE	Data Dictionary	\|Definition\| \|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For claims where Medicaid payment is only available at the header level, report the entire payment amount on the T-MSIS record corresponding to the line item with the highest charge or the 1st detail. Zero fill Medicaid Amount Paid on all other MSIS records created from the original claim.\|	\|Definition\| \|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.\|
08/13/2021	3.0.0	TYPE-OF-SERVICE (	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|TYPE-OF-SERVICE\|00010101\|99991231\|147\|Residential Pediatric Recovery Center (RPRC): A center or facility that furnishes items and services for which medical assistance is available under the State plan to infants with the diagnosis of neonatal abstinence syndrome without any other significant medical risk factors.\|
06/24/2022	3.0.0	PRV046	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\| PRV046\|ADDR-TYPE	DE NO\| DATA ELEMENT NAME COMPUTING\| PRV046\|PROV-ADDR-TYPE
06/24/2022	3.0.0	ELG065	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\| ELG065\|ADDR-TYPE	DE NO\| DATA ELEMENT NAME COMPUTING\| ELG065\|ELIGIBLE-ADDR-TYPE
09/03/2021	3.0.0	RULE-1244	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '009', '044', '045', '046', '047', '048', '050', '059', '133', '136', '137', '146'	‘if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: ‘26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '009', '044', '045', '046', '047', '048', '050', '059', '133', '136', '137', '146', '147’
09/03/2021	3.0.0	RULE-1656	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '127', '131', '134', '135', '136', '137', '138', '139', '140', '141', '142', '143', '144'	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', ‘030', ‘031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '127', '131', '134', '135', '136', '137', '138', '139', '140', '141', '142', '143', '144', '147’
08/13/2021	3.0.0	RULE-7303	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM or CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM
08/13/2021	3.0.0	RULE-7311	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' then CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NPI-NUM	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' then CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NPI-NUM
05/13/2022	3.0.0	CRX143	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME\|DEFINITION\| CRX143\|DRUG-UTILIZATION-CODE\|A code indicating the conflict, intervention and outcome of a prescription presented for fulfillment. The T-MSIS Drug Utilization Code data element is composite field comprised of three distinct NCPDP data elements: "Reason for Service Code" (439-E4); "Professional Service Code" (44-E5); and "Result of Service Code" (441-E6). All 3 of these NCPDP fields are situationally required and independent of one another. Pharmacists may report none, one, two or all three. NCPDP situational rules call for one or more of these values in situations where the field(s) could result in different coverage, pricing, patient financial responsibility, drug utilization review outcome, or if the information affects payment for, or documentation of, professional pharmacy service. The NCPDP "Results of Service Code" (bytes 1 & 2 of the T-MSIS Drug Utilization Code) explains whether the pharmacist filled the prescription, filled part of the prescription, etc. The NCPDP "Professional Service Code" (bytes 3 & 4 of the T-MSIS Drug Utilization Code) describes what the pharmacist did for the patient. The NCPDP "Result of Service Code" (bytes 5 & 6 of the T-MSIS Drug Utilization Code) describes the action the pharmacist took in response to a conflict or the result of a pharmacist's professional service. Because the T-MSIS Drug Utilization Code data element is a composite field, it is necessary for the state to populate all six bytes if any of the three NCPDP fields has a value. In such situations, use 'spaces' as placeholders for not applicable codes.\|	DE NO\| DATA ELEMENT NAME\|DEFINITION\| CRX143\|DRUG-UTILIZATION-CODE\|A code indicating the conflict, intervention and outcome of a prescription presented for fulfillment. The T-MSIS Drug Utilization Code data element is composite field comprised of three distinct NCPDP data elements: "Reason for Service Code" (439-E4); "Professional Service Code" (440-E5); and "Result of Service Code" (441-E6). All 3 of these NCPDP fields are situationally required and independent of one another. Pharmacists may report none, one, two or all three. NCPDP situational rules call for one or more of these values in situations where the field(s) could result in different coverage, pricing, patient financial responsibility, drug utilization review outcome, or if the information affects payment for, or documentation of, professional pharmacy service.The NCPDP "Reason for Service Code" (bytes 1 & 2 of the T-MSIS Drug Utilization Code) explains whether the pharmacist filled the prescription, filled part of the prescription, etc. The NCPDP "Professional Service Code" (bytes 3 & 4 of the T-MSIS Drug Utilization Code) describes what the pharmacist did for the patient. The NCPDP "Result of Service Code" (bytes 5 & 6 of the T-MSIS Drug Utilization Code) describes the action the pharmacist took in response to a conflict or the result of a pharmacist's professional service. Because the T-MSIS Drug Utilization Code data element is a composite field, it is necessary for the state to populate all six bytes if any of the three NCPDP fields has a value. In such situations, use 'spaces' as placeholders for not applicable codes.\|
01/07/2022	3.0.0	ELG260	UPDATE	Data Dictionary	\|FILE SEGMENT NAME WITH RECORD ID COMPUTING\| \|ELIGIBLE-IDENTIFIER-ELG00022\|	\|FILE SEGMENT NAME WITH RECORD ID COMPUTING\| \|ELIGIBLE-IDENTIFIERS-ELG00022\|
06/24/2022	3.0.0	MFP-QUALIFIED-RESIDENCE	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| ELG152\|MFP-QUALIFIED-RESIDENCE\|A code describing type of qualified institution at the time of transition to the community for an eligible MFP Demonstration participant.\|	DE No\|Data Element Name\|Definition\|CODING REQUIREMENT\| ELG152\|MFP-QUALIFIED-RESIDENCE\|A code indicating the type of qualified residence.\|
09/03/2021	3.0.0	RULE-7305	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', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NUM	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.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NUM
09/03/2021	3.0.0	RULE-7306	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 one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NUM	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NUM
09/03/2021	3.0.0	RULE-7307	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM
09/03/2021	3.0.0	RULE-7308	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NUM	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NUM
09/03/2021	3.0.0	RULE-7208	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', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C"), then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE'	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 TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE'
09/03/2021	3.0.0	RULE-7209	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', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', and TYPE-OF-CLAIM in ("1","3","A","C") then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'	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-LINE-RECORD-IP.CLAIM-LINE-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 TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
09/03/2021	3.0.0	RULE-7210	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', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', and TYPE-OF-CLAIM in ("1","3","A","C") then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'	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-LINE-RECORD-IP.CLAIM-LINE-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 TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
09/03/2021	3.0.0	RULE-7211	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', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.PATIENT-STATUS does not equal '30' and TYPE-OF-CLAIM in ("1","3","A","C"), then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for DISCHARGE-DATE'	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.PATIENT-STATUS does not equal '30' and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for DISCHARGE-DATE'
09/03/2021	3.0.0	RULE-7212	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.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C"), then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
09/03/2021	3.0.0	RULE-7213	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.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C"), then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
09/03/2021	3.0.0	RULE-7214	UPDATE	Data Dictionary - Validation Rules	IF CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is NOT in (Z)AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is NOT in ("26","026","87","087", "542","585", "654", "686") AND CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C") THEN CLAIM-HEADER-RX.PRESCRIPTION-FILL-DATE must have a valid, non-null and not invalidly formatted value	IF CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is NOT in (Z)AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: "26","026","87","087", "542","585", "654" AND CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' THEN CLAIM-HEADER-RX.PRESCRIPTION-FILL-DATE must have a valid, non-null and not invalidly formatted value
09/03/2021	3.0.0	RULE-7252	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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C"), then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-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' 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-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
09/03/2021	3.0.0	RULE-7253	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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C"), then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-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' 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-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
09/03/2021	3.0.0	RULE-7215	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C","2","B"), then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4', and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', '2', 'B', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
09/03/2021	3.0.0	RULE-7216	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C","2","B"), then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4', and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', '2', 'B', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
09/03/2021	3.0.0	RuLE-7217	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C","2","B"), then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4', and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
09/03/2021	3.0.0	RULE-7218	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C","2","B") then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4', and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
10/15/2021	3.0.0	RULE-7254	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', '686' then CLAIM-HEADER-RECORD-IP has a non-null value for TYPE-OF-CLAIM'	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', then CLAIM-HEADER-RECORD-IP has a non-null value for TYPE-OF-CLAIM'
10/15/2021	3.0.0	RULE-7255	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' then CLAIM-HEADER-RECORD-LT has a non-null value for TYPE-OF-CLAIM'	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', then CLAIM-HEADER-RECORD-LT has a non-null value for TYPE-OF-CLAIM'
10/15/2021	3.0.0	RULE-7256	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-CLAIM'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-CLAIM'
10/15/2021	3.0.0	RULE-7257	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' then CLAIM-HEADER-RECORD-RX has a non-null value for TYPE-OF-CLAIM'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-RX has a non-null value for TYPE-OF-CLAIM'
10/15/2021	3.0.0	RULE-7258	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', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-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 "0" or "4"and TYPE-OF-CLAIM in ("1","3","A","C")then CLAIM-LINE-RECORD-IP has a non-null value for TYPE-OF-SERVICE'	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-LINE-RECORD-IP.CLAIM-LINE-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 "0" or "4"and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-IP has a non-null value for TYPE-OF-SERVICE'
10/15/2021	3.0.0	RULE-7259	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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0" or "4"and TYPE-OF-CLAIM in ("1","3","A","C") then CLAIM-LINE-RECORD-LT has a non-null value for TYPE-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' 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-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0" or "4" and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-LT has a non-null value for TYPE-OF-SERVICE'
10/15/2021	3.0.0	RULE-7260	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" or "4"and TYPE-OF-CLAIM in ("1","3","A","C") then CLAIM-LINE-RECORD-OT has a non-null value for TYPE-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" or "4" and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-OT has a non-null value for TYPE-OF-SERVICE'
10/15/2021	3.0.0	RULE-7261	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0" or "4"and TYPE-OF-CLAIM in ("1","3","A","C")then CLAIM-LINE-RECORD-RX has a non-null value for TYPE-OF-SERVICE'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0" or "4" and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-RX has a non-null value for TYPE-OF-SERVICE'
10/15/2021	3.0.0	RULE-7262	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', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-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 "0" or "4"and TYPE-OF-CLAIM in ("1","A") then CLAIM-LINE-RECORD-IP has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'	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-LINE-RECORD-IP.CLAIM-LINE-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 "0" or "4" and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-IP has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'
10/15/2021	3.0.0	RULE-7263	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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0" or "4"and TYPE-OF-CLAIM in ("1","A")then CLAIM-LINE-RECORD-LT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'	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' 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-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0" or "4" and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-LT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'
10/15/2021	3.0.0	RULE-7264	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" or "4"and TYPE-OF-CLAIM in ("1","A","2","B") then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal ‘0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal ‘Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" or "4" and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '2’, 'B’, then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'
10/15/2021	3.0.0	RULE-7265	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0" or "4" and TYPE-OF-CLAIM in ("1","A")then CLAIM-LINE-RECORD-RX has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0" or "4" and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-RX has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'
08/13/2021	3.0.0	TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|00010101\|99991231\|1\|Hospice (Nonhospital Based)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|00010101\|99991231\|2\|Hospice (Hospital Based)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|00010101\|99991231\|3\|Ambulatory Surgical Center Services to Hospital Outpatients\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|00010101\|99991231\|4\|Free Standing Birthing Center\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|00010101\|99991231\|5\|Critical Access Hospital\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|00010101\|99991231\|6\|Residential Facility\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|20210101\|99991231\|7\|Freestanding Non-residential Opioid Treatment Program (Effective 1/1/21)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|00010101\|99991231\|8\|Reserved for National Assignment\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|00010101\|99991231\|9\|OTHER\|
09/03/2021	3.0.0	RULE-7459	UPDATE	Data Dictionary - Validation Rules	if WAIVER-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM and WAIVER-TYPE is equal to one of the following: '02', '03', '04', '05', '06', '07', '08','09', '10', '11, '12', '13', '14', '15', '16', '17', '18','19', '20', '32', '33' then substr(WAIVER-PARTICIPATION.WAIVER-ID, 1, 2) must be in (A-Z/a-z) and substr(WAIVER-PARTICIPATION.WAIVER-ID, 3, 1) must be equal to '.' and substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 4) must be equal to 0-9 digits)	if WAIVER-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM and WAIVER-TYPE is equal to one of the following: '02', '03', '04', '05', '06', '07', '08','09', '10', '11, '12', '13', '14', '15', '16', '17', '18','19', '20', '32', '33' then substr(WAIVER-PARTICIPATION.WAIVER-ID, 1, 2) must be in (A-Z/a-z) and substr(WAIVER-PARTICIPATION.WAIVER-ID, 3, 1) must be equal to '.' and (substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 4) must be equal to 0-9 digits or substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 5) must be equal to 0-9 digits)
09/03/2021	3.0.0	RULE-7473	UPDATE	Data Dictionary - Validation Rules	'if PROV-IDENTIFIERS has a non-null value for PROV-IDENTIFIER and PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2', then PROV-IDENTIFIERS.PROV-IDENTIFIER is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file and PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE is greater than or equal to "Provider Enumeration Date" from the NPPES NPI data file	N/A
10/15/2021	3.0.0	HCPCS	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|HCPCS\|20210603\|99991231\|Q0244\|Casirivi and imdevi 1200 mg \|Injection, casirivimab and imdevimab, 1200 mg\| \|HCPCS\|20210506\|99991231\|M0244\|Casirivi and imdevi inj hm\|Intravenous infusion or subcuteaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency\| \|HCPCS\|20210624\|99991231\|Q0249\|Tocilizumab for COVID-19\|Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg\| \|HCPCS\|20210624\|99991231\|M0249\|Adm Tocilizu COVID-19 1st\|Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose\| \|HCPCS\|20210624\|99991231\|M0250\|Adm Tocilizu COVID-19 2nd\|Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose\| \|HCPCS\|20210506\|99991231\|M0246\|Bamlan and etesev infus home\|Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency\| \|HCPCS\|20210506\|99991231\|Q0247\|Sotrovimab\|Injection, sotrovimab, 500 mg\| \|HCPCS\|20210506\|99991231\|M0247\|Sotrovimab infusion\|Intravenous infusion, sotrovimab, includes infusion and post administration monitoring\| \|HCPCS\|20210506\|99991231\|M0248\|Sotrovimab inf, home admin\|Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency\| \|HCPCS\|20210506\|999912311\|M0201\|Covid-19 vaccine home admin\|Covid-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient's home\| \|HCPCS\|20201109\|20210416\|Q0239\|Bamlanivimab-xxxx\|Injection, bamlanivimab, 700 mg\| \|HCPCS\|20201109\|20210416\|M0239\|Bamlanivimab-xxxx infusion\|Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring\| \|HCPCS\|20210730\|99991231\|Q0240\|Casirivi and imdevi 600mg\|Injection, casirivimab and imdevimab, 600 mg\| \|HCPCS\|20210730\|99991231\|M0240\|Casiri and imdev repeat\|Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses\| \|HCPCS\|20210730\|99991231\|M0241\|Casiri and imdev repeat hm\|Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence, this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency, subsequent repeat doses\| \|HCPCS\|20201121\|99991231\|Q0243\|Casirivimab and imdevimab\|Injection, casirivimab and imdevimab, 2400 mg\| \|HCPCS\|20201121\|99991231\|M0243\|Casirivi and imdevi inj\|Intravenous infusion or subcuteaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring\| \|HCPCS\|20210209\|99991231\|M0245\|Bamlan and etesev infusion\|Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring\| \|HCPCS\|20210209\|99991231\|Q0245\|Bamlanivimab and etesevima\|Injection, bamlanivimab and etesevimab, 2100 mg\|
10/15/2021	3.0.0	RULE-7301	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', '686’ and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM	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.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM
10/15/2021	3.0.0	RULE-7309	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', '686’ and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686’ 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: '1','3','A','C', then CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NPI-NUM	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-LINE-RECORD-IP.CLAIM-LINE-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: '1','3','A','C', then CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NPI-NUM
10/15/2021	3.0.0	RULE-7302	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 one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM
10/15/2021	3.0.0	RULE-7310	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-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686’ and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NPI-NUM	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' 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-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NPI-NUM
10/15/2021	3.0.0	RULE-7304	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal ‘F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686’ and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM
10/15/2021	3.0.0	RULE-7312	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal ‘F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686’ and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI
09/03/2021	3.0.0	TYPE-OF-SERVICE	UPDATE	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|TYPE-OF-SERVICE\|00010101\|99991231\|147\|Residential Pediatric Recovery Center (RPRC): A center or facility that furnishes items and services for which medical assistance is available under the State plan to infants with the diagnosis of neonatal abstinence syndrome without any other significant medical risk factors.\|
10/15/2021	3.0.0	CITIZENSHIP-IND	UPDATE	Data Dictionary - Valid Values	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|CITIZENSHIP-IND\|00010101\|99991231\|1\|U.S. Citizen\| \|CITIZENSHIP-IND\|00010101\|99991231\|2\|U.S. National\|	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|CITIZENSHIP-IND\|00010101\|99991231\|1\|U.S. Citizen (If the state’s eligibility determination system does not distinguish between U.S. citizens and U.S. nationals who are not U.S. citizens, then use this value for all U.S. citizens and U.S. nationals (see 42 CFR 435 and 436.).)\| \|CITIZENSHIP-IND\|00010101\|99991231\|2\|U.S. National (If the state’s eligibility determination system does distinguish between U.S. citizens and U.S. nationals who are not U.S. citizens, then use this value for U.S. nationals who are not U.S. citizens (see 42 CFR 435 and 436.).)\|
10/15/2021	3.0.0	RULE-7553	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to '01', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP is equal to '23'
10/15/2021	3.0.0	RULE-7554	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to '05', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP is equal to '24'
10/15/2021	3.0.0	RULE-7555	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to '03', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP is equal to '25'
10/15/2021	3.0.0	RULE-7556	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to '06', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP is equal to '26'
11/05/2021	3.0.0	RULE-7459	UPDATE	Data Dictionary - Validation Rules	if WAIVER-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUMand WAIVER-TYPE is equal to one of the following: '02', '03', '04', '05', '06', '07', '08','09', '10', '11, '12', '13', '14', '15', '16', '17', '18','19', '20', '32', '33' then substr(WAIVER-PARTICIPATION.WAIVER-ID, 1, 2) must be in (A-Z/a-z) and substr(WAIVER-PARTICIPATION.WAIVER-ID, 3, 1) must be equal to '.' and (substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 4) must be equal to 0-9 digits or substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 5) must be equal to 0-9 digits)	if WAIVER-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM and WAIVER-TYPE is equal to one of the following: '02', '03', '04', '05', '06', '07', '08','09', '10', '11, '12', '13', '14', '15', '16', '17', '18','19', '20', '32', '33' then substr(WAIVER-PARTICIPATION.WAIVER-ID, 1, 2) must be in (A-Z/a-z) and substr(WAIVER-PARTICIPATION.WAIVER-ID, 3, 1) must be equal to '.' and (substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 4) must be equal to 0-9 digits or substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 5) must be equal to 0-9 digits) or substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 2) must be equal to 0-9 digits)
10/15/2021	3.0.0	CLAIM-STATUS-CATEGORY (CIP103)	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \|CODING REQUIREMENT\| \|CIP103 \|CLAIM-STATUS-CATEGORY\| Not Applicable \|Not Applicable \|(Denied Claim) if associated Type of Claim equals Z or associated Claim Status is in [ 26, 87, 542, 858, 654 ], then value must be "F2"\| \|CLT055 \|CLAIM-STATUS-CATEGORY\| Not Applicable \|Not Applicable \|(Denied Claim) if associated Type of Claim equals Z or associated Claim Status is in [ 26, 87, 542, 858, 654 ], then value must be "F2"\| \|COT040 \|CLAIM-STATUS-CATEGORY\| Not Applicable \|Not Applicable \|(Denied Claim) if associated Type of Claim equals Z or associated Claim Status is in [ 26, 87, 542, 858, 654 ], then value must be "F2"\| \|CRX031 \|CLAIM-STATUS-CATEGORY\| Not Applicable \|Not Applicable \|(Denied Claim) if associated Type of Claim equals Z or associated Claim Status is in [ 26, 87, 542, 858, 654 ], then value must be "F2"\|	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \|CODING REQUIREMENT\| \|CIP103 \|CLAIM-STATUS-CATEGORY\| Not Applicable \|Not Applicable \|(Denied Claim) if associated Type of Claim equals Z or associated Claim Status is in [ 26, 87, 542, 585, 654 ], then value must be "F2"\| \|CLT055 \|CLAIM-STATUS-CATEGORY\| Not Applicable \|Not Applicable \|(Denied Claim) if associated Type of Claim equals Z or associated Claim Status is in [ 26, 87, 542, 585, 654 ], then value must be "F2"\| \|COT040 \|CLAIM-STATUS-CATEGORY\| Not Applicable \|Not Applicable \|(Denied Claim) if associated Type of Claim equals Z or associated Claim Status is in [ 26, 87, 542, 585, 654 ], then value must be "F2"\| \|CRX031 \|CLAIM-STATUS-CATEGORY\| Not Applicable \|Not Applicable \|(Denied Claim) if associated Type of Claim equals Z or associated Claim Status is in [ 26, 87, 542, 585, 654 ], then value must be "F2"\|
11/05/2021	3.0.0	RULE-7557	ADD	Data Dictionary - Validation Rules	N/A	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CITIZENSHIP-IND equals '1', then VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for CITIZENSHIP-VERIFICATION-FLAG'
11/05/2021	3.0.0	RULE-7559	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10', and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE, then VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-BENEFICIARY-IDENTIFIER or VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-HIC-NUM
11/05/2021	3.0.0	Rule-7558	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBLE-CONTACT-INFORMATION.MSIS-IDENTIFICATION-NUM has a non-null value, then ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-PHONE-NUM'
11/05/2021	3.0.0	RULE-7560	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-IP has a null value for MEDICAID-PAID-AMT or CLAIM-LINE-RECORD-IP.MEDICAID-PAID-AMT equals '0.00''
11/05/2021	3.0.0	RULE-7561	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-LT has a null value for MEDICAID-PAID-AMT or CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT equals '0.00''
11/05/2021	3.0.0	RULE-7562	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-OT has a null value for MEDICAID-PAID-AMT or CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT equals '0.00''
11/05/2021	3.0.0	RULE-7563	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-RX has a null value for MEDICAID-PAID-AMT or CLAIM-LINE-RECORD-RX.MEDICAID-PAID-AMT equals '0.00''
10/15/2021	3.0.0	Rule-7564	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and substr(CLAIM-LINE-RECORD-OT.PROCEDURE-CODE,1,1) is equal to 'D' and CLAIM-HEADER-RECORD-OT has a non-null value for DIAGNOSIS-CODE-FLAG-1,then CLAIM-HEADER-RECORD-OT has a non-null value for DIAGNOSIS-CODE-1
12/03/2021	3.0.0	RACE	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|RACE\|00010101\|99991231\|018\|Other\|
12/03/2021	3.0.0	RACE (ELG213)	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \|CODING REQUIREMENT\| \|ELG213\|RACE\| Not Applicable \|Not Applicable \|A code indicating the individual's race either in accordance with requirements of Section 4302 of the Affordable Care Act classifications Race Code clarifications: If state has beneficiaries coded in their database as "Asian" with no additional detail, then code them in T-MSIS as "Asian Unknown" (valid value "011"). DO NOT USE "Other Asian," "Unspecified" or "Unknown." If state has beneficiaries coded in their database as "Native Hawaiian or Other Pacific Islander" with no additional detail, then code them in T-MSIS as "Native Hawaiian and Other Pacific Islander Unknown" (valid value "016"). DO NOT USE "Native Hawaiian," "Other Pacific Islander," "Unspecified" or "Unknown."NOTE 1: The "Other Asian" category in T-MSIS (valid value "010") should be used in situations in which an individual's specific Asian subgroup is not available in the code set provided (e.g., Malaysian, Burmese).NOTE 2: The "Unspecified" category in T-MSIS (valid value "017") should be used with an individual who explicitly did not provide information or refused to answer a question\|	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \|CODING REQUIREMENT\| \|ELG213\|RACE\| Not Applicable \|Not Applicable \|A code indicating the individual's race in accordance with requirements of Section 4302 of the Affordable Care Act classifications Race Code clarifications: If state has beneficiaries coded in their database as "Asian" with no additional detail, then code them in T-MSIS as "Asian Unknown" (valid value "011"). DO NOT USE "Other Asian," "Unspecified" or "Unknown." If state has beneficiaries coded in their database as "Native Hawaiian or Other Pacific Islander" with no additional detail, then code them in T-MSIS as "Native Hawaiian and Other Pacific Islander Unknown" (valid value "016"). DO NOT USE "Native Hawaiian," "Other Pacific Islander," "Unspecified" or "Unknown." If state has beneficiaries coded in their database as “Other” with no additional detail or in a category that is not available in the code set provided, then code them in T-MSIS as “Other” (valid value “018”), but only use “Other” if the use of “Other Asian” or “Other Pacific Islander” are not appropriate. DO NOT USE “Unspecified” or “Unknown”. The “Other” valid value was added to T-MSIS to better align T-MSIS with the single-streamlined application and to accommodate some atypical states, despite the requirements of Section 4302 of the ACA.NOTE 1: The "Other Asian" category in T-MSIS (valid value "010") should be used in situations in which an individual's specific Asian subgroup is not available in the code set provided (e.g., Malaysian, Burmese).NOTE 2: The "Unspecified" category in T-MSIS (valid value "017") should be used with an individual who explicitly did not provide information or refused to answer a question.\|
06/24/2022	3.0.0	ELG271/ ETHNICITY-OTHER	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT ELG271\|ETHNICITY-OTHER \|X(25)\|ELIGIBLE\|ETHNICITY-INFORMATION-ELG00015
11/05/2021	3.0.0	RULE-7569	ADD	Data Dictionary - Validation Rules	N/A	if PROV-ATTRIBUTES-MAIN has a non-null value for SUBMITTING-STATE-PROV-ID and PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03', then there is no more than one PROV-IDENTIFIERS segment with matching join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2'
10/15/2021	3.0.0	PROV-IDENTIFIER-TYPE (PRV077)	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|PROV-IDENTIFIER-TYPE\|00010101\|99991231\|9\|Old State Provider ID
12/03/2021	3.0.0	PROV-CLASSIFICATION-TYPE = 3 (Provider Type Code)	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|PROV-CLASSIFICATION-TYPE = 3 (Provider Type Code)\|00010101\|99991231\|58\|Institutions for Mental Disease\|
11/05/2021	3.0.0	Rule-7565	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT equals '0.00''
11/05/2021	3.0.0	Rule-7566	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT equals '0.00''
11/05/2021	3.0.0	Rule-7567	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT equals '0.00''
11/05/2021	3.0.0	Rule-7568	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT equals '0.00''
12/17/2021	3.0.0	PROV-SPECIALTY	ADD	Data Dictionary - Valid Values	add valid value to file PROV-SPECIALTY.psv	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION PROV-SPECIALTY\|00010101\|99991231\|88\|Unknown Supplier/Provider Specialty\|
11/05/2021	3.0.0	PROV-CLASSIFICATION-TYPE = 4	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|89\|Disposable medical supplies\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|90\|Critical access hospital services - IP\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|91\|Skilled care - hospital residing\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|92\|Exceptional care - hospital residing\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|93\|Non-acute care - hospital residing\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|120\|Capitated payments for primary care case management (PCCM)\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|123\|Disproportionate share hospital (DSH) payments\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|127\|Indian Health Service (IHS) - Family Plan\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|132\|Supplemental payment - inpatient\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|133\|Supplemental payment - nursing\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|134\|Supplemental payment - outpatient\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|135\|EHR payments to provider\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|136\|In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal Regulations) administered during any portion of the emergency period defined in paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, and the administration of such in vitro diagnostic products\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|137\|COVID–19 testing-related services\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|138\|Per member per month (PMPM) payments for health home services\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|143\|Per member per month (PMPM) payments for other payments\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|144\|Payments to individuals for personal assistance services under 1915(j)\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|145\|Medication Assisted Treatment (MAT) services and drugs for evidenced-based treatment of Opioid Use Disorder (OUD) in accordance with section 1905(a)(29) of the Social Security Act\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|146\|Inpatient Psychiatric Services for beneficiaries between the ages of 22 and 64 who receive services in an institution for mental disease (IMD)\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|147\|Residential Pediatric Recovery Center (RPRC): A center or facility that furnishes items and services for which medical assistance is available under the State plan to infants with the diagnosis of neonatal abstinence syndrome without any other significant medical risk factors.\|
12/03/2021	3.0.0	ELIGIBILITY-CHANGE-REASON	UPDATE	Data Dictionary - Valid Values	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|09\|No longer in need of long-term care services resides\|	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|09\|No longer in need of long-term care services\|
06/24/2022	3.0.0	CIP296/ IHS-SERVICE-IND	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP296\|IHS-SERVICE-IND\|X(1)\|\|CLAIMIP\|CLAIM-LINE-RECORD-IP-CIP00003
06/24/2022	3.0.0	CLT243/ IHS-SERVICE-IND	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CLT243\|IHS-SERVICE-IND\|X(1)\|CLAIMLT\|CLAIM-LINE-RECORD-LT-CLT00003
06/24/2022	3.0.0	COT234/ IHS-SERVICE-IND	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT234\|IHS-SERVICE-IND\|X(1)\|CLAIMOT\|CLAIM-LINE-RECORD-OT-COT00003
06/24/2022	3.0.0	CRX172/ IHS-SERVICE-IND	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX172\|IHS-SERVICE-IND\|X(1)\|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003
12/17/2021	3.0.0	PROCEDURE-CODE-MOD	UPDATE	Data Dictionary - Valid Values	\|Modifier\|Effective Date\|End Date\|Description\| \|DD\|20210101\|99991231\|FROM Diagnostic or therapeutic site TO Diagnostic or therapeutic site\| \|DE\|20210101\|99991231\|FROM Diagnostic or therapeutic site TO Residential, domiciliary, custodial facility (other than 1819 facility)\| \|DG\|20210101\|99991231\|FROM Diagnostic or therapeutic site TO Hospital based ESRD facility\| \|DH\|20210101\|99991231\|FROM Diagnostic or therapeutic site TO Hospital\| \|DI\|20210101\|99991231\|FROM Diagnostic or therapeutic site TO Site of transfer\| \|DJ\|20210101\|99991231\|FROM Diagnostic or therapeutic site TO Freestanding ESRD facility\| \|DN\|20210101\|99991231\|FROM Diagnostic or therapeutic site TO Skilled nursing facility\| \|DP\|20210101\|99991231\|FROM Diagnostic or therapeutic site TO Physician’s office\| \|DR\|20210101\|99991231\|FROM Diagnostic or therapeutic site TO Residence\| \|DS\|20210101\|99991231\|FROM Diagnostic or therapeutic site TO Scene of accident or acute event\| \|DX\|20210101\|99991231\|FROM Diagnostic or therapeutic site TO Intermediate stop at Physician’s office on way to Hospital\|	\|Modifier\|Effective Date\|End Date\|Description\| \|DD\|00010101\|99991231\|FROM Diagnostic or therapeutic site TO Diagnostic or therapeutic site\| \|DE\|00010101\|99991231\|FROM Diagnostic or therapeutic site TO Residential, domiciliary, custodial facility (other than 1819 facility)\| \|DG\|00010101\|99991231\|FROM Diagnostic or therapeutic site TO Hospital based ESRD facility\| \|DH\|00010101\|99991231\|FROM Diagnostic or therapeutic site TO Hospital\| \|DI\|00010101\|99991231\|FROM Diagnostic or therapeutic site TO Site of transfer\| \|DJ\|00010101\|99991231\|FROM Diagnostic or therapeutic site TO Freestanding ESRD facility\| \|DN\|00010101\|99991231\|FROM Diagnostic or therapeutic site TO Skilled nursing facility\| \|DP\|00010101\|99991231\|FROM Diagnostic or therapeutic site TO Physician’s office\| \|DR\|00010101\|99991231\|FROM Diagnostic or therapeutic site TO Residence\| \|DS\|00010101\|99991231\|FROM Diagnostic or therapeutic site TO Scene of accident or acute event\| \|DX\|00010101\|99991231\|FROM Diagnostic or therapeutic site TO Intermediate stop at Physician’s office on way to Hospital\|
12/17/2021	3.0.0	PROCEDURE-CODE-MOD	UPDATE	Data Dictionary - Valid Values	\|Modifier\|Effective Date\|End Date\|Description\| \|EG\|20210101\|99991231\|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Hospital based ESRD facility\| \|EH\|20210101\|99991231\|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Hospital\| \|EI\|20210101\|99991231\|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Site of transfer\| \|EN\|20210101\|99991231\|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Skilled nursing facility\| \|ES\|20210101\|99991231\|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Scene of accident or acute event\| \|GI\|20210101\|99991231\|FROM Hospital based ESRD facility TO Site of transfer\| \|ID\|20210101\|99991231\|FROM Site of transfer TO Diagnostic or therapeutic site\| \|IE\|20210101\|99991231\|FROM Site of transfer TO Residential, domiciliary, custodial facility (other than 1819 facility)\| \|IG\|20210101\|99991231\|FROM Site of transfer TO Hospital based ESRD facility\| \|IH\|20210101\|99991231\|FROM Site of transfer TO Hospital\| \|II\|20210101\|99991231\|FROM Site of transfer TO Site of transfer\| \|IJ\|20210101\|99991231\|FROM Site of transfer TO Freestanding ESRD facility\| \|IN\|20210101\|99991231\|FROM Site of transfer TO Skilled nursing facility\| \|IP\|20210101\|99991231\|FROM Site of transfer TO Physician’s office\|	\|Modifier\|Effective Date\|End Date\|Description\| \|EG\|00010101\|99991231\|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Hospital based ESRD facility\| \|EH\|00010101\|99991231\|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Hospital\| \|EI\|00010101\|99991231\|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Site of transfer\| \|EN\|00010101\|99991231\|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Skilled nursing facility\| \|ES\|00010101\|99991231\|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Scene of accident or acute event\| \|GI\|00010101\|99991231\|FROM Hospital based ESRD facility TO Site of transfer\| \|ID\|00010101\|99991231\|FROM Site of transfer TO Diagnostic or therapeutic site\| \|IE\|00010101\|99991231\|FROM Site of transfer TO Residential, domiciliary, custodial facility (other than 1819 facility)\| \|IG\|00010101\|99991231\|FROM Site of transfer TO Hospital based ESRD facility\| \|IH\|00010101\|99991231\|FROM Site of transfer TO Hospital\| \|II\|00010101\|99991231\|FROM Site of transfer TO Site of transfer\| \|IJ\|00010101\|99991231\|FROM Site of transfer TO Freestanding ESRD facility\| \|IN\|00010101\|99991231\|FROM Site of transfer TO Skilled nursing facility\| \|IP\|00010101\|99991231\|FROM Site of transfer TO Physician’s office\|
12/17/2021	3.0.0	PROCEDURE-CODE-MOD	UPDATE	Data Dictionary - Valid Values	\|Modifier\|Effective Date\|End Date\|Description\| \|IR\|20210101\|99991231\|FROM Site of transfer TO Residence\| \|IS\|20210101\|99991231\|FROM Site of transfer TO Scene of accident or acute event\| \|IX\|20210101\|99991231\|FROM Site of transfer TO Intermediate stop at Physician’s office on way to Hospital\| \|JH\|20210101\|99991231\|FROM Freestanding ESRD facility TO Hospital\| \|JI\|20210101\|99991231\|FROM Freestanding ESRD facility TO Site of transfer\| \|JJ\|20210101\|99991231\|FROM Freestanding ESRD facility TO Freestanding ESRD facility\| \|JN\|20210101\|99991231\|FROM Freestanding ESRD facility TO Skilled nursing facility\| \|JP\|20210101\|99991231\|FROM Freestanding ESRD facility TO Physician’s office\| \|JR\|20210101\|99991231\|FROM Freestanding ESRD facility TO Residence\| \|JS\|20210101\|99991231\|FROM Freestanding ESRD facility TO Scene of accident or acute event\| \|JX\|20210101\|99991231\|FROM Freestanding ESRD facility TO Intermediate stop at Physician’s office on way to Hospital\| \|ND\|20210101\|99991231\|FROM Skilled nursing facility TO Diagnostic or therapeutic site\| \|NE\|20210101\|99991231\|FROM Skilled nursing facility TO Residential, domiciliary, custodial facility (other than 1819 facility)\| \|NG\|20210101\|99991231\|FROM Skilled nursing facility TO Hospital based ESRD facility\|	\|Modifier\|Effective Date\|End Date\|Description\| \|IR\|00010101\|99991231\|FROM Site of transfer TO Residence\| \|IS\|00010101\|99991231\|FROM Site of transfer TO Scene of accident or acute event\| \|IX\|00010101\|99991231\|FROM Site of transfer TO Intermediate stop at Physician’s office on way to Hospital\| \|JH\|00010101\|99991231\|FROM Freestanding ESRD facility TO Hospital\| \|JI\|00010101\|99991231\|FROM Freestanding ESRD facility TO Site of transfer\| \|JJ\|00010101\|99991231\|FROM Freestanding ESRD facility TO Freestanding ESRD facility\| \|JN\|00010101\|99991231\|FROM Freestanding ESRD facility TO Skilled nursing facility\| \|JP\|00010101\|99991231\|FROM Freestanding ESRD facility TO Physician’s office\| \|JR\|00010101\|99991231\|FROM Freestanding ESRD facility TO Residence\| \|JS\|00010101\|99991231\|FROM Freestanding ESRD facility TO Scene of accident or acute event\| \|JX\|00010101\|99991231\|FROM Freestanding ESRD facility TO Intermediate stop at Physician’s office on way to Hospital\| \|ND\|00010101\|99991231\|FROM Skilled nursing facility TO Diagnostic or therapeutic site\| \|NE\|00010101\|99991231\|FROM Skilled nursing facility TO Residential, domiciliary, custodial facility (other than 1819 facility)\| \|NG\|00010101\|99991231\|FROM Skilled nursing facility TO Hospital based ESRD facility\|
12/17/2021	3.0.0	PROCEDURE-CODE-MOD	UPDATE	Data Dictionary - Valid Values	\|Modifier\|Effective Date\|End Date\|Description\| \|NH\|20210101\|99991231\|FROM Skilled nursing facility TO Hospital\| \|NI\|20210101\|99991231\|FROM Skilled nursing facility TO Site of transfer\| \|NJ\|20210101\|99991231\|FROM Skilled nursing facility TO Freestanding ESRD facility\| \|NN\|20210101\|99991231\|FROM Skilled nursing facility TO Skilled nursing facility\| \|NP\|20210101\|99991231\|FROM Skilled nursing facility TO Physician’s office\| \|NS\|20210101\|99991231\|FROM Skilled nursing facility TO Scene of accident or acute event\| \|NX\|20210101\|99991231\|FROM Skilled nursing facility TO Intermediate stop at Physician’s office on way to Hospital\| \|PD\|20210101\|99991231\|FROM Physician’s office TO Diagnostic or therapeutic site\| \|PE\|20210101\|99991231\|FROM Physician’s office TO Residential, domiciliary, custodial facility (other than 1819 facility)\| \|PG\|20210101\|99991231\|FROM Physician’s office TO Hospital based ESRD facility\| \|PH\|20210101\|99991231\|FROM Physician’s office TO Hospital\| \|PI\|20210101\|99991231\|FROM Physician’s office TO Site of transfer\| \|PJ\|20210101\|99991231\|FROM Physician’s office TO Freestanding ESRD facility\| \|PN\|20210101\|99991231\|FROM Physician’s office TO Skilled nursing facility\| \|PP\|20210101\|99991231\|FROM Physician’s office TO Physician’s office\| \|PR\|20210101\|99991231\|FROM Physician’s office TO Residence\| \|PX\|20210101\|99991231\|FROM Physician’s office TO Intermediate stop at Physician’s office on way to Hospital \|RG\|20210101\|99991231\|FROM Residence TO Hospital based ESRD facility	\|Modifier\|Effective Date\|End Date\|Description\| \|NH\|00010101\|99991231\|FROM Skilled nursing facility TO Hospital\| \|NI\|00010101\|99991231\|FROM Skilled nursing facility TO Site of transfer\| \|NJ\|00010101\|99991231\|FROM Skilled nursing facility TO Freestanding ESRD facility\| \|NN\|00010101\|99991231\|FROM Skilled nursing facility TO Skilled nursing facility\| \|NP\|00010101\|99991231\|FROM Skilled nursing facility TO Physician’s office\| \|NS\|00010101\|99991231\|FROM Skilled nursing facility TO Scene of accident or acute event\| \|NX\|00010101\|99991231\|FROM Skilled nursing facility TO Intermediate stop at Physician’s office on way to Hospital\| \|PD\|00010101\|99991231\|FROM Physician’s office TO Diagnostic or therapeutic site\| \|PE\|00010101\|99991231\|FROM Physician’s office TO Residential, domiciliary, custodial facility (other than 1819 facility)\| \|PG\|00010101\|99991231\|FROM Physician’s office TO Hospital based ESRD facility\| \|PH\|00010101\|99991231\|FROM Physician’s office TO Hospital\| \|PI\|00010101\|99991231\|FROM Physician’s office TO Site of transfer\| \|PJ\|00010101\|99991231\|FROM Physician’s office TO Freestanding ESRD facility\| \|PN\|00010101\|99991231\|FROM Physician’s office TO Skilled nursing facility\| \|PP\|00010101\|99991231\|FROM Physician’s office TO Physician’s office\| \|PR\|00010101\|99991231\|FROM Physician’s office TO Residence\| \|PX\|00010101\|99991231\|FROM Physician’s office TO Intermediate stop at Physician’s office on way to Hospital \|RG\|00010101\|99991231\|FROM Residence TO Hospital based ESRD facility
12/17/2021	3.0.0	PROCEDURE-CODE-MOD	UPDATE	Data Dictionary - Valid Values	\|Modifier\|Effective Date\|End Date\|Description\| \|RN\|20210101\|99991231\|FROM Residence TO Skilled nursing facility\| \|RS\|20210101\|99991231\|FROM Residence TO Scene of accident or acute event\| \|RX\|20210101\|99991231\|FROM Residence TO Intermediate stop at Physician’s office on way to Hospital\| \|SI\|20210101\|99991231\|FROM Scene of accident or acute event TO Site of transfer\| \|SP\|20210101\|99991231\|FROM Scene of accident or acute event TO Physician’s office\| \|SR\|20210101\|99991231\|FROM Scene of accident or acute event TO Residence\| \|SX\|20210101\|99991231\|FROM Scene of accident or acute event TO Intermediate stop at Physician’s office on way to Hospital\|	\|Modifier\|Effective Date\|End Date\|Description\| \|RN\|00010101\|99991231\|FROM Residence TO Skilled nursing facility\| \|RS\|00010101\|99991231\|FROM Residence TO Scene of accident or acute event\| \|RX\|00010101\|99991231\|FROM Residence TO Intermediate stop at Physician’s office on way to Hospital\| \|SI\|00010101\|99991231\|FROM Scene of accident or acute event TO Site of transfer\| \|SP\|00010101\|99991231\|FROM Scene of accident or acute event TO Physician’s office\| \|SR\|00010101\|99991231\|FROM Scene of accident or acute event TO Residence\| \|SX\|00010101\|99991231\|FROM Scene of accident or acute event TO Intermediate stop at Physician’s office on way to Hospital\|
12/17/2021	3.0.0	BILLING-PROV-NUM (COT112)	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \|CODING REQUIREMENT\| \|COT112\|BILLING-PROV-NUM\| Not Applicable \|Not Applicable \|Value must be reported in Provider Identifier (PRV.005.080) with an associated Provider Identifier Type (PRV.005.081) equal to '1'\|	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \|CODING REQUIREMENT\| \|COT112\|BILLING-PROV-NUM\| Not Applicable \|Not Applicable \|When Type of Service (COT.003.186) not in ('119', ‘120’, ‘122’), then value must be reported in Provider Identifier (PRV.005.080) with an associated Provider Identifier Type (PRV.005.081) equal to '1'\|
12/17/2021	3.0.0	BILLING-PROV-NUM (COT112)	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \|CODING REQUIREMENT\| \|COT112\|BILLING-PROV-NUM\| Not Applicable \|Not Applicable \|Not Applicable\|	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \|CODING REQUIREMENT\| \|COT112\|BILLING-PROV-NUM\| Not Applicable \|Not Applicable \|When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider IDorWhen Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type = '1'\|
12/17/2021	3.0.0	BILLING-PROV-NUM (COT112)	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \|CODING REQUIREMENT\| \|COT112\|BILLING-PROV-NUM\| Not Applicable \|Not Applicable \|When Type of Service (COT..003.186) is in ['119', ‘120', '122'] value must match Plan ID Number (COT.002.066)\|	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \|CODING REQUIREMENT\| \|COT112\|BILLING-PROV-NUM\| Not Applicable \|Not Applicable \|Not Applicable\|
06/24/2022	3.0.0	ELG269/ ELIGIBLE-FEDERAL-POVERTY-LEVEL-PERCENTAGE	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT ELG269\|ELIGIBLE-FEDERAL-POVERTY-LEVEL-PERCENTAGE\|9(3)\|ELIGIBLE\|VARIABLE-DEMOGRAPHICS-ELIGIBILITY-ELG00003
12/03/2021	3.0.0	RULE-7570	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY equals 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR equals '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM equals 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type CLAIM-LINE-RECORD-IP that matches on the join keys
12/03/2021	3.0.0	RULE-7571	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY equals 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR equals '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM equals 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type CLAIM-LINE-RECORD-LT that matches on the join keys
12/03/2021	3.0.0	RULE-7572	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY equals 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR equals '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM equals 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type CLAIM-LINE-RECORD-OT that matches on the join keys
12/03/2021	3.0.0	RULE-7573	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY equals 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR equals '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM equals 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type CLAIM-LINE-RECORD-RX that matches on the join keys
01/07/2022	3.0.0	ELG086	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \|CODING REQUIREMENT\| \|ELG086\|PRIMARY-ELIGIBILITY-GROUP-IND\| Not Applicable \|Not Applicable \|A person enrolled in Medicaid/CHIP should always have a primary eligibility group classification for any given day of enrollment. (There may or may not be a secondary eligibility group classification for that same day.) It is expected that an enrollee's eligibility group assignment (ELG087 - ELIGIBILITY-GROUP) will change over time as his/her situation changes. Whenever the eligibility group assignment changes (i.e., ELG087 has a different value), a separate ELIGIBILITY-DETERMINANTS record segment must be created. In such situations, there would be multiple ELIGIBILITY-DETERMINANTS record segments, each covering a different effective time span. In such situations, the value in ELG087 would be the primary eligibility group for the effective date span of its respective ELIGIBILITY-DETERMINANTS record segment, and the PRIMARY-ELIGIBILITY-GROUP-IND data element on each of these segments would be set to '1' (YES).\|
01/07/2022	3.0.0	ELG086	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \|CODING REQUIREMENT\| \|ELG086\|PRIMARY-ELIGIBILITY-GROUP-IND\| Not Applicable \|Not Applicable \|Should a situation arise where a Medicaid/CHIP enrollee has been assigned both a primary and one or more secondary eligibility groups, there would be two or more ELIGIBILITY-DETERMINANTS record segments with overlapping effective time spans - one segment containing the primary eligibility group and the other(s) for the secondary eligibility group(s). To differentiate the primary eligibility group from the secondary group(s), only one segment should be assigned as the primary group using PRIMARY-ELIGIBILITY-GROUP-IND = 1; the others should be assigned PRIMARY-ELIGIBILITY-GROUP-IND = 0.\|
12/03/2021	3.0.0	XIX-MBESCBES-CATEGORY-OF-SERVICE	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20210311\|99991231\|47\|ARP Section 9811 COVID Vaccine/Vaccine Administration\|
02/18/2022	3.0.0	RULE-7168	UPDATE	Data Dictionary - Validation Rules	if MANAGED-CARE-MAIN.MANAGED-CARE-SERVICE-AREA equals '2' and MANAGED-CARE-SERVICE-AREA has a valid, non-null value for MANAGED-CARE-SERVICE-AREA-NAME, then If the field is populated, the value must be contained in the set of valid values with id: 'COUNTY' and (if MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE is non-null then MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE >= Valid Values Effective-Date and MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE <= Valid Values End-Date)	if MANAGED-CARE-MAIN.MANAGED-CARE-SERVICE-AREA equals '2' and MANAGED-CARE-SERVICE-AREA has a valid, non-null value for MANAGED-CARE-SERVICE-AREA-NAME, then if the length(MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-NAME) = 5, the value must be contained in the set of valid values with id: 'COUNTY' Else if the Length (MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-NAME) = 3 then CONCAT(MANAGED-CARE-MAIN.SUBMITTING-STATE, MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-NAME)the value must be contained in the set of valid values with id: 'COUNTY' and (if MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE is non-null then MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE >= Valid Values Effective-Date and MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE <= Valid Values End-Date)'
06/24/2022	3.0.0	CIP292/ TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP292\|TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT \|S9(11)V99\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002
06/24/2022	3.0.0	CIP293/ TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP293\|TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT \|S9(11)V99\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002
06/24/2022	3.0.0	CIP294/ TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP294\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|S9(11)V99\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002
06/24/2022	3.0.0	CIP295/ COMBINED-BENE-COST-SHARING-PAID-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP295\|COMBINED-BENE-COST-SHARING-PAID-AMOUNT \|S9(11)V99\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002
06/24/2022	3.0.0	CLT239/ TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CLT239\|TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT\|S9(11)V99\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002
06/24/2022	3.0.0	CLT240/ TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT- CLT240\|TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT\|S9(11)V99\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002
06/24/2022	3.0.0	CLT241/ TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CLT241\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|S9(11)V99\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002
06/24/2022	3.0.0	CLT242/ COMBINED-BENE-COST-SHARING-PAID-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CLT242\|COMBINED-BENE-COST-SHARING-PAID-AMOUNT\|S9(11)V99\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002
06/24/2022	3.0.0	COT230/ TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT230\|TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT\|S9(11)V99\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002
06/24/2022	3.0.0	COT231/ TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT231\|TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT\|S9(11)V99\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002
06/24/2022	3.0.0	COT232/ TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT232\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|S9(11)V99\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002
06/24/2022	3.0.0	COT233/ COMBINED-BENE-COST-SHARING-PAID-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT233\|COMBINED-BENE-COST-SHARING-PAID-AMOUNT\|S9(11)V99\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002
06/24/2022	3.0.0	CRX163/ TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX163\|TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT\|S9(11)V99\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002
06/24/2022	3.0.0	CRX164/ TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX164\|TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT\|S9(11)V99\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002
06/24/2022	3.0.0	CRX165/ TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX165\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|S9(11)V99\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002
06/24/2022	3.0.0	CRX166/ COMBINED-BENE-COST-SHARING-PAID-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX166\|COMBINED-BENE-COST-SHARING-PAID-AMOUNT\|S9(11)V99\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002
06/24/2022	3.0.0	CIP115/ TOT-COPAY-AMT	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CIP115\|TOT-COPAY-AMT\|S9(11)V99\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002	N/A
06/24/2022	3.0.0	CLT066/ TOT-COPAY-AMT	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CLT066\|TOT-COPAY-AMT\|S9(11)V99\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002	N/A
06/24/2022	3.0.0	COT051/ TOT-COPAY-AMT	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT COT051\|TOT-COPAY-AMT\|S9(11)V99\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002	N/A
06/24/2022	3.0.0	CRX042/ TOT-COPAY-AMT	Deprecate DE	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX042\|TOT-COPAY-AMT\|S9(11)V99\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002	N/A
06/24/2022	3.0.0	COT176/ BENEFICIARY-COPAYMENT-PAID-AMOUNT	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name COT176\|COPAY-AMT	DE No\|Data Element Name COT176\|BENEFICIARY-COPAYMENT-PAID-AMOUNT
06/24/2022	3.0.0	CRX123/ BENEFICIARY-COPAYMENT-PAID-AMOUNT	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CRX123\|COPAY-AMT	DE No\|Data Element Name CRX123\|BENEFICIARY-COPAYMENT-PAID-AMOUNT
06/24/2022	3.0.0	COT132	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION COT132\|BENEFICIARY-COPAYMENT-AMOUNT\|The amount of money the beneficiary paid towards a co-payment.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION COT132\|TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT\|The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on the claim. Do not include copayment payments made by a third party/ies on behalf of the beneficiary.
06/24/2022	3.0.0	COT130	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION COT130\|BENEFICIARY-COINSURANCE-AMOUNT\|The amount of money the beneficiary paid towards coinsurance.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION COT130\|TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT\|The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their coinsurance for the covered services on the claim. Do not include coinsurance payments made by a third party/ies on behalf of the beneficiary.
06/24/2022	3.0.0	COT134	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION COT134\|BENEFICIARY-DEDUCTIBLE-AMOUNT\|The amount of money the beneficiary paid towards an annual deductible.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION COT134\|TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT\|The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their deductible for the covered services on the claim. Do not include deductible payments made by a third party/ies on behalf of the beneficiary.
06/24/2022	3.0.0	CIP206/ TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CIP206\|BENEFICIARY-COINSURANCE-AMOUNT	DE No\|Data Element Name \| CIP206\|TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT
06/24/2022	3.0.0	CIP208/ TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CIP208\|BENEFICIARY-COPAYMENT-AMOUNT	DE No\|Data Element Name CIP208\|TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT
06/24/2022	3.0.0	CIP210/ TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CIP210\|BENEFICIARY-DEDUCTIBLE-AMOUNT	DE No\|Data Element Name CIP210\|TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT
06/24/2022	3.0.0	CLT153/ TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CLT153\|BENEFICIARY-COINSURANCE-AMOUNT	DE No\|Data Element Name CLT153\|TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT
06/24/2022	3.0.0	CLT155/ TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CLT155\|BENEFICIARY-COPAYMENT-AMOUNT	DE No\|Data Element Name CLT155\|TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT
06/24/2022	3.0.0	CLT157/ TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CLT157\|BENEFICIARY-DEDUCTIBLE-AMOUNT	DE No\|Data Element Name CLT157\|TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT
06/24/2022	3.0.0	COT130/ TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name COT130\|BENEFICIARY-COINSURANCE-AMOUNT	DE No\|Data Element Name COT130\|TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT
06/24/2022	3.0.0	COT132/ TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name COT132\|BENEFICIARY-COPAYMENT-AMOUNT	DE No\|Data Element Name COT132\|TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT
06/24/2022	3.0.0	COT134/ TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name COT134\|BENEFICIARY-DEDUCTIBLE-AMOUNT	DE No\|Data Element Name COT134\|TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT
06/24/2022	3.0.0	CRX087/ TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CRX087\|BENEFICIARY-COINSURANCE-AMOUNT	DE No\|Data Element Name CRX087\|TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT
06/24/2022	3.0.0	CRX089/ TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CRX089\|BENEFICIARY-COPAYMENT-AMOUNT	DE No\|Data Element Name CRX089\|TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT
06/24/2022	3.0.0	CRX092/ TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CRX092\|BENEFICIARY-DEDUCTIBLE-AMOUNT	DE No\|Data Element Name CRX092\|TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT
12/17/2021	3.0.0	RULE-7574	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-IP has corresponding parent record CLAIM-HEADER-RECORD-IP
12/17/2021	3.0.0	RULE-7575	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-LT has corresponding parent record CLAIM-HEADER-RECORD-LT
12/17/2021	3.0.0	RULE-7576	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-OT has corresponding parent record CLAIM-HEADER-RECORD-OT
12/17/2021	3.0.0	RULE-7577	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-RX has corresponding parent record CLAIM-HEADER-RECORD-RX
12/03/2021	3.0.0	RULE-7578	ADD	Data Dictionary - Validation Rules	N/A	Records with the same primary keys (excluding any date fields) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' must have non-overlapping date ranges. Effective date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE
12/03/2021	3.0.0	RULE-7409	UPDATE	Data Dictionary - Validation Rules	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '2'and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01’and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '07','31','61'	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '2'and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to ‘2015-01-01’and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND = '1’ and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '07','31','61'
12/03/2021	3.0.0	RULE-7410	UPDATE	Data Dictionary - Validation Rules	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '3' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’ then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM) and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)) and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01’ and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '61','62','63','64','65','66','67','68'	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '3'and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’ then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM) and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)) and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to ‘2015-01-01’ and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND = '1 and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '61','62','63','64','65','66','67','68'
12/03/2021	3.0.0	RULE-7422	UPDATE	Data Dictionary - Validation Rules	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1'and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01' then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01’and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is not equal to one of the following: '61','62','63','64','65','66','67','68'	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1'and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’ then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01’and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND = '1’and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is not equal to one of the following: '61','62','63','64','65','66','67','68'
12/17/2021	3.0.0	PROCEDURE-CODE-MOD	ADD	Data Dictionary - Valid Values	add values to the PROCEDURE-CODE-MOD.psv	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| PROCEDURE-CODE-MOD\|20070701\|99991231\|1P\|Performance Measure Exclusion Modifier due to Medical Reasons\| PROCEDURE-CODE-MOD\|20070701\|99991231\|2P\|Performance Measure Exclusion Modifier due to Patient Reasons\| PROCEDURE-CODE-MOD\|20070701\|99991231\|3P\|Performance Measure Exclusion Modifier due to System Reasons \|
05/24/2019	2.3.0	RULE-971	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X', then CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT equals '0.00''	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT equals '0.00''
12/17/2021	3.0.0	RULE-1656	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '127', '131', '134', '135', '136', '137', '138', '139', '140', '141', '142', '143', '144', '147''	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', ‘030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '127', '131', '134', '135', '136', '137', '138', '139', '140', '141', '142', '143', '144', '145’,'147''
12/17/2021	3.0.0	RULE-1938	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '011', '018', '033', '034', '036', '085', '089', '127', '131', '136', '137''	‘if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '011', '018', '033', '034', '036', '085', '089', '127', '131', '136', '137', '145’'
12/17/2021	3.0.0	XXI-MBESCBES-CATEGORY-OF-SERVICE	ADD	Data Dictionary - Valid Values	add values to XXI-MBESCBES-CATEGORY-OF-SERVICE.psv	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|2A\|Inpatient Hospital Services - DSH\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|3A\|Inpatient Mental Health - DSH\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|3B\|Certified Community Behavior Health Clinic Payments\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|8A2\|Drug Rebate - State\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|8A3\|MCO - National Agreement\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|8A4\|MCO - State Sidebar Agreement\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|8A5\|Increased ACA OFFSET - Fee for Service - 100%\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|8A6\|Increased ACA OFFSET - MCO - 100%\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|21A\|Home and Community-Based Services - Regular Payment (WAIVER)\|
06/24/2022	3.0.0	ELG270	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME ELG270\|LOCKED-IN-SRVCS\|Conditional\|The type(s) of service that are locked-in\|Value must be 3 characters\|ELIGIBLE\|LOCK-IN-INFORMATION-ELG00009
06/24/2022	3.0.0	ELG269	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME ELG269\|ELIGIBLE-FEDERAL-POVERTY-LEVEL-PERCENTAGE \|Conditional\|The beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the one that applies to their primary eligibility group.\|(LVR) value must be between 0 and 400 inclusively\|ELIGIBLE\|VARIABLE-DEMOGRAPHICS-ELIGIBILITY-ELG00003
06/24/2022	3.0.0	ELG271	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME ELG271\|ETHNICITY-OTHER\|Conditional\|A freeform field to document the ethnicity of the beneficiary when the beneficiary identifies themselves as Another Hispanic, Latino, or Spanish origin (ethnicity code 4)\|If associated Ethnicity-Code (ELG.015.204) value is in [ "4"], then value must be populated.\|ELIGIBLE\|ETHNICITY-INFORMATION-ELG00015
06/24/2022	3.0.0	ELG194	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME ELG194\|NATIONAL-HEALTH-CARE-ENTITY-ID	N/A
06/24/2022	3.0.0	ELG195	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME ELG195\|NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE	N/A
06/24/2022	3.0.0	ELG045	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME ELG045\|PRIMARY-LANGUAGE-ENGL-PROF-CODE	\|DE NO\| DATA ELEMENT NAME ELG045\|ENGL-PROF-CODE
06/24/2022	3.0.0	ELG215	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME ELG215\|CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR	\|DE NO\| DATA ELEMENT NAME ELG215\|AMERICAN-INDIAN-ALASKA-NATIVE-INDICATOR
12/17/2021	3.0.0	RULE-7558	UPDATE	Data Dictionary - Validation Rules	if ELIGIBLE-CONTACT-INFORMATION.MSIS-IDENTIFICATION-NUM has a non-null value, then ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-PHONE-NUM'	if ELIGIBLE-CONTACT-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM, and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-TYPE equals '01', then ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-PHONE-NUM'
01/07/2022	3.0.0	ELG233	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|ELG233\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration.\|	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|ELG233\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115A demonstration. 1115A is a Center for Medicare and Medicaid Innovation demonstration.\|
01/07/2022	3.0.0	CIP025	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|CIP025\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration.\|	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|CIP025\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115A demonstration. 1115A is a Center for Medicare and Medicaid Innovation demonstration.\|
01/07/2022	3.0.0	CLT024	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|CLT024\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration.\|	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|CLT024\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115A demonstration. 1115A is a Center for Medicare and Medicaid Innovation demonstration.\|
01/07/2022	3.0.0	COT024	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|COT024\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration.\|	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|COT024\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115A demonstration. 1115A is a Center for Medicare and Medicaid Innovation demonstration.\|
01/07/2022	3.0.0	CRX024	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|CRX024\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration.\|	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|CRX024\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115A demonstration. 1115A is a Center for Medicare and Medicaid Innovation demonstration.\|
12/17/2021	3.0.0	ADJUDICATION-DATE	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CIP098\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|CLT050\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|COT035\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|CRX027\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|CIP286\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|CLT233\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|COT221\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|CRX157\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\|	\|DE No\|Data Element Name\|Definition\| \|CIP098\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|CLT050\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|COT035\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|CRX027\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|CIP286\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|CLT233\|ADJUDICATION-DATE\|TThe date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|COT221\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|CRX157\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\|
01/28/2022	3.0.0	Rule-7579	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X’, then CLAIM-HEADER-RECORD-IP. MEDICAID-AMOUNT-PAID-DSH is NULL or equal to '0.00’
01/28/2022	3.0.0	RULE-7580	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.CLAIM-STATUS is not equal to one of the following: ‘26', ‘026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to '132’, then CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4','D','X'
01/28/2022	3.0.0	RULE-7581	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.CLAIM-STATUS is not equal to one of the following: ‘26', ‘026', '87', '087', '542', '585', '654' 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.TYPE-OF-SERVICE is equal to '133', then CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X'
01/28/2022	3.0.0	RULE-7582	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal ‘0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: ‘26', ‘026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to '134', then CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X'
12/17/2021	3.0.0	RULE-7553	UPDATE	Data Dictionary - Validation Rules	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '01', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP equals '23''	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '01' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP equals '23'
12/17/2021	3.0.0	RULE-7554	UPDATE	Data Dictionary - Validation Rules	'if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '05', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP equals '24''	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '05', and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP equals '24''
12/17/2021	3.0.0	RULE-7555	UPDATE	Data Dictionary - Validation Rules	'if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '03', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP equals '25''	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '03' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP equals '25'
12/17/2021	3.0.0	RULE-7556	UPDATE	Data Dictionary - Validation Rules	'if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '06', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP equals '26''	if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '06' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP equals '26''
12/03/2021	3.0.0	XXI-MBESCBES-CATEGORY-OF-SERVICE	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|XXI-MBESCBES-CATEGORY-OF-SERVICE\|20210311\|99991231\|26\|ARP Section 9821 COVID Vaccine/Vaccine Administration\|
04/01/2022	3.0.0	RULE-7633	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 is not equal to 'Z' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' then CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'
04/01/2022	3.0.0	RULE-7634	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 is not equal to 'Z' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' then CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'
04/01/2022	3.0.0	RULE-7635	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to 'Z' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654', and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654', then CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'
04/01/2022	3.0.0	RULE-7636	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to 'Z' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: ''026', '087’,26', '87', '542', '585', '654' then CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'
06/24/2022	3.0.0	MCR091/ RECORD-ID, MCR092/ SUBMITTING-STATE, MCR093/ RECORD-NUMBER, MCR094/ STATE-PLAN-ID-NUM, MCR095/ NATIONAL-HEALTH-CARE-ENTITY-ID, MCR096/ NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE, MCR097/ NATIONAL-HEALTH-CARE-ENTITY-NAME, MCR098/ NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE, MCR099/ NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-END-DATE, MCR0100/ STATE-NOTATION, MCR0101/ FILLER	Deprecate Segment	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT MCR091\|RECORD-ID\|X(8)\|MNGDCARE\|NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-MCR00008 MCR092\|SUBMITTING-STATE\|X(2)\|MNGDCARE\|NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-MCR00008 MCR093\|RECORD-NUMBER\|9(11)\|MNGDCARE\|NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-MCR00008 MCR094\|STATE-PLAN-ID-NUM\|X(12)\|MNGDCARE\|NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-MCR00008 MCR095\|NATIONAL-HEALTH-CARE-ENTITY-ID\|X(10)\|MNGDCARE\|NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-MCR00008 MCR096\|NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE\|X(1)\|MNGDCARE\|NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-MCR00008 MCR097\|NATIONAL-HEALTH-CARE-ENTITY-NAME\|X(50)\|MNGDCARE\|NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-MCR00008 MCR098\|NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE\|9(8)\|MNGDCARE\|NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-MCR00008 MCR099\|NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-END-DATE\|9(8)\|MNGDCARE\|NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-MCR00008 MCR0100\|STATE-NOTATION\|X(500)\|MNGDCARE \|NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-MCR00008 MCR0101\|FILLER\|X(390)\|MNGDCARE\|NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-MCR00008	N/A
06/24/2022	3.0.0	MCR102/ RECORD-ID, MCR103/ SUBMITTING-STATE, MCR104/ RECORD-NUMBER, MCR105/ STATE-PLAN-ID-NUM, MCR106/ CHPID, MCR107/ SHPID, MCR108/ CHPID-SHPID-RELATIONSHIP-EFF-DATE, MCR109/ CHPID-SHPID-RELATIONSHIP-END-DATE, MCR110/ STATE-NOTATION, MCR111/ FILLER	Deprecate Segment	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT MCR102\|RECORD-ID\|X(8)\|MNGDCARE\|CHPID-SHPID-RELATIONSHIPS-MCR00009 MCR103\|SUBMITTING-STATE\|X(2)\|MNGDCARE\|CHPID-SHPID-RELATIONSHIPS-MCR00009 MCR104\|RECORD-NUMBER\|9(11)\|MNGDCARE\|CHPID-SHPID-RELATIONSHIPS-MCR00009 MCR105\|STATE-PLAN-ID-NUM\|X(12)\|MNGDCARE\|CHPID-SHPID-RELATIONSHIPS-MCR00009 MCR106\|CHPID\|X(8)\|MNGDCARE\|CHPID-SHPID-RELATIONSHIPS-MCR00009 MCR107\|SHPID\|X(10)\|MNGDCARE \|CHPID-SHPID-RELATIONSHIPS-MCR00009 MCR108\|CHPID-SHPID-RELATIONSHIP-EFF-DATE\|9(8)\|MNGDCARE \|CHPID-SHPID-RELATIONSHIPS-MCR00009 MCR109\|CHPID-SHPID-RELATIONSHIP-END-DATE\|9(8)\|MNGDCARE \|CHPID-SHPID-RELATIONSHIPS-MCR00009 MCR110\|STATE-NOTATION\|X(500)\|MNGDCARE \|CHPID-SHPID-RELATIONSHIPS-MCR00009 MCR111\|FILLER\|X(431)\|MNGDCARE\|CHPID-SHPID-RELATIONSHIPS-MCR00009	N/A
06/24/2022	3.0.0	TPL093	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME TPL093\|NATIONAL-HEALTH-CARE-ENTITY-ID	N/A
06/24/2022	3.0.0	TPL092	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME TPL092\|NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE	N/A
06/24/2022	3.0.0	TPL094	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME TPL094\|NATIONAL-HEALTH-CARE-ENTITY-NAME	N/A
03/11/2022	3.0.0	RULE-7565	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT equals '0.00''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY equals 'F2' or CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR equals '0' or CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM equals 'Z' or CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT equals '0.00''
03/11/2022	3.0.0	RULE-7566	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT equals '0.00''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY equals 'F2' or CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR equals '0' or CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM equals 'Z' or CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT equals '0.00''
03/11/2022	3.0.0	RULE-7567	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT equals '0.00''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY equals 'F2' or CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR equals '0' or CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM equals 'Z' or CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT equals '0.00''
03/11/2022	3.0.0	RULE-7568	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT equals '0.00''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY equals 'F2' or CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR equals '0' or CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM equals 'Z' or CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT equals '0.00''
04/01/2022	3.0.0	RULE-7587	ADD	Data Dictionary - Validation Rules	N/A	if PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE-PROV-ID equal to a non-null value and PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE is equal to one of the following values: '01', '02' then for every record of type PROV-ATTRIBUTES-MAIN, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys (SUBMITTING-STATE, SUBMITTING-STATE-PROV-ID) and PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2' and PROV-IDENTIFIERS.PROV-IDENTIFIER is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file and the "Entity Type Code" is equal to '2' in the NPPES data file.
04/01/2022	3.0.0	RULE-7589	ADD	Data Dictionary - Validation Rules	N/A	if PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE-PROV-ID equal to a non-null value and PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE is equal to '03' then for every record of type PROV-ATTRIBUTES-MAIN, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys (SUBMITTING-STATE, SUBMITTING-STATE-PROV-ID) and PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2' and PROV-IDENTIFIERS.PROV-IDENTIFIER is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file and the "Entity Type Code" is equal to '1' in the NPPES data file.
04/01/2022	3.0.0	RULE-7593	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal ‘0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: ‘26', ‘026', ‘87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', 'V’ and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE has a non-null value and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to the one of following: '119’, '120', '121', '122', '138’,'139’, '140’, '141’, '142’, '143’, '144’
06/24/2022	3.0.0	Rule-7590	ADD	Data Dictionary - Validation Rules	N/A	Value must be compatible with specified T-MSIS picture format: X(3)
06/24/2022	3.0.0	Rule-7591	ADD	Data Dictionary - Validation Rules	N/A	Value must be compatible with specified T-MSIS picture format: 9(3)
06/24/2022	3.0.0	Rule-7592	ADD	Data Dictionary - Validation Rules	N/A	Value must be compatible with specified T-MSIS picture format: X(25)
03/11/2022	3.0.0	RULE-2382	UPDATE	Data Dictionary - Validation Rules	If MANAGED-CARE-PARTICIPATION has a non-null value for MANAGED-CARE-PLAN-ID then for every record of type MANAGED-CARE-PARTICIPATION, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is greater than or equal to MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is less than or equal to MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE	If MANAGED-CARE-PARTICIPATION has a non-null value for MANAGED-CARE-PLAN-ID and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN- ENROLLMENT-END-DATE is greater than or equal to ‘cutover date' then for every record of type MANAGED-CARE-PARTICIPATION, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and MAX(MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, 'cutover date’) is greater than or equal to MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is less than or equal to MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE
03/11/2022	3.0.0	RULE-2384	UPDATE	Data Dictionary - Validation Rules	if MANAGED-CARE-PARTICIPATION has a valid, non-null value for ENROLLED-MANAGED-CARE-PLAN-TYPE and MANAGED-CARE-MAIN has a valid, non-null value for MANAGED-CARE-PLAN-TYPE, then MANAGED-CARE-PARTICIPATION.ENROLLED-MANAGED-CARE-PLAN-TYPE equals MANAGED-CARE-MAIN.MANAGED-CARE-PLAN-TYPE'	if MANAGED-CARE-PARTICIPATION has a valid, non-null value for ENROLLED-MANAGED-CARE-PLAN-TYPE and MANAGED-CARE-MAIN has a valid, non-null value for MANAGED-CARE-PLAN-TYPE, and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN- ENROLLMENT-END-DATE is greater than or equal to ‘cutover date' then MANAGED-CARE-PARTICIPATION.ENROLLED-MANAGED-CARE-PLAN-TYPE equals MANAGED-CARE-MAIN.MANAGED-CARE-PLAN-TYPE' and MAX(MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, 'cutover date’) is greater than or equal to MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is less than or equal to MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE
01/28/2022	3.0.0	RULE-7191	UPDATE	Data Dictionary - Validation Rules	if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '1', then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE), where VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '1', '2'	if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '1', then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (MAX(ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE, null) >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE), and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '1', '2'
01/28/2022	3.0.0	RULE-7192	UPDATE	Data Dictionary - Validation Rules	if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '2', then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE), where VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '3'	if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '2', then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (MAX(ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE, null) >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE), and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '3'
01/28/2022	3.0.0	RULE-7409	UPDATE	Data Dictionary - Validation Rules	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '2'and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01’and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '07','31','61'	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '2' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’ then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM) and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)) and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to ‘2015-01-01’ and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND = '1’ and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '07','31','61'
01/28/2022	3.0.0	RULE-7410	UPDATE	Data Dictionary - Validation Rules	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '3'and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01’and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '61','62','63','64','65','66','67','68'	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '3' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’ then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM) and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to ‘2015-01-01’ and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND = '1’ and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '61','62','63','64','65','66','67','68'
01/28/2022	3.0.0	RULE-7422	UPDATE	Data Dictionary - Validation Rules	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1'and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)) and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01’and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is not equal to one of the following: '61','62','63','64','65','66','67','68'	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’ then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM) and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)) and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01’and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND = '1’ and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is not equal to one of the following: '61','62','63','64','65','66','67','68'
01/28/2022	3.0.0	RULE-7427	UPDATE	Data Dictionary - Validation Rules	if WAIVER-PARTICIPATION.WAIVER-TYPE is equal to '24', then for every record of type WAIVER-PARTICIPATION, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM), and (WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE >= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE <= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE), and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to '6'	if WAIVER-PARTICIPATION.WAIVER-TYPE equals '24', then for every record of type WAIVER-PARTICIPATION, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and (MAX(WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE, null) >= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE <= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE), and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '6'
01/28/2022	3.0.0	RULE-7428	UPDATE	Data Dictionary - Validation Rules	if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to 'C', and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) and (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE), and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '3'	f ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals 'C' and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1', then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (MAX(ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, null) >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE), and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '3'
01/28/2022	3.0.0	RULE-7429	UPDATE	Data Dictionary - Validation Rules	if MFP-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM then for every record of type MFP-INFORMATION, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) and (MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and MFP-INFORMATION.MFP-ENROLLMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE), and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to 'D'	if MFP-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM, then for every record of type MFP-INFORMATION, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and (MAX(MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE, null) >= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and MFP-INFORMATION.MFP-ENROLLMENT-END-DATE <= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE), and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals 'D'
01/28/2022	3.0.0	RULE-7430	UPDATE	Data Dictionary - Validation Rules	if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to 'D' and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type MFP-INFORMATION that matches on the join keys (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE >= MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE)	if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals 'D' and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1', then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (MAX(ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, null) >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE)
01/28/2022	3.0.0	RULE-7529	UPDATE	Data Dictionary - Validation Rules	if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '2', and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) and (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE) and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.IMMIGRATION-STATUS is equal to one of the following: '1', '2', '3'	if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '2' and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1', then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (MAX(ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, null) >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE), and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.IMMIGRATION-STATUS is equal to one of the following: '1', '2', '3'
01/28/2022	3.0.0	RULE-7538	UPDATE	Data Dictionary - Validation Rules	if ENROLLMENT-TIME-SPAN has a non-null value for MSIS-IDENTIFICATION-NUM then for every record of type ENROLLMENT-TIME-SPAN, there must be a valid record of type PRIMARY-DEMOGRAPHICS that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) and ENROLLMENT-TIME-SPAN.ENROLLMENT-EFF-DATE is greater than or equal to PRIMARY-DEMOGRAPHICS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN.ENROLLMENT-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE	if ENROLLMENT-TIME-SPAN-SEGMENT has a non-null value for MSIS-IDENTIFICATION-NUM, then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (MAX(ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE, null) >= PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE)
01/28/2022	3.0.0	RULE-7539	UPDATE	Data Dictionary - Validation Rules	if ENROLLMENT-TIME-SPAN has a non-null value for MSIS-IDENTIFICATION-NUM then for every record of type ENROLLMENT-TIME-SPAN, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) and (ENROLLMENT-TIME-SPAN.ENROLLMENT-EFF-DATE is greater than or equal to VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN.ENROLLMENT-END-DATE is less than or equal to VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE)	if ENROLLMENT-TIME-SPAN-SEGMENT has a non-null value for MSIS-IDENTIFICATION-NUM, then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (MAX(ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE, null) >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE)
01/28/2022	3.0.0	RULE-7540	UPDATE	Data Dictionary - Validation Rules	if ENROLLMENT-TIME-SPAN has a non-null value for MSIS-IDENTIFICATION-NUM then for every record of type ENROLLMENT-TIME-SPAN, there must be a valid record of type ELIGIBLITY-DETERMINANTS that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-Num) and ELIGIBLITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' and (ENROLLMENT-TIME-SPAN.ENROLLMENT-EFF-DATE >= ELIGIBLITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and ENROLLMENT-TIME-SPAN.ENROLLMENT-END-DATE <= ELIGIBLITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)	if ENROLLMENT-TIME-SPAN-SEGMENT has a non-null value for MSIS-IDENTIFICATION-NUM, then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and (MAX(ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE, null) >= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE), and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1'
04/22/2022	3.0.0	RULE-2212	UPDATE	Data Dictionary - Validation Rules	For every record of type HEALTH-HOME-SPA-PROVIDERS, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys	if HEALTH-HOME-SPA-PROVIDERS has a non-null value for HEALTH-HOME-SPA-NAMEand HEALTH-HOME-SPA-PROVIDERS.HEALTH-HOME-SPA-PROVIDER-END-DATE is greater than or equal to 'cutover date' then for every record of type HEALTH-HOME-SPA-PROVIDERS, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys and (Max(HEALTH-HOME-SPA-PROVIDERS.HEALTH-HOME-SPA-PROVIDER-EFF-DATE, 'cutover date')) is greater than or equal to PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and HEALTH-HOME-SPA-PROVIDERS.HEALTH-HOME-SPA-PROVIDER-END-DATE is less than or equal to PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE
04/22/2022	3.0.0	RULE-2258	UPDATE	Data Dictionary - Validation Rules	For every record of type LOCK-IN-INFORMATION, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys	if LOCK-IN-INFORMATION has a non-null value for LOCKIN-PROV-NUM and LOCK-IN-INFORMATION.LOCKIN-END-DATE is greater than or equal to 'cutover date' then for every record of type LOCK-IN-INFORMATION, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys and (Max(LOCK-IN-INFORMATION.LOCKIN-EFF-DATE, 'cutover date')) is greater than or equal to PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and LOCK-IN-INFORMATION.LOCKIN-END-DATE is less than or equal to PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE
04/22/2022	3.0.0	RULE-2357	UPDATE	Data Dictionary - Validation Rules	For every record of type LTSS-PARTICIPATION, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys	if LTSS-PARTICIPATION has a non-null value for LTSS-PROV-NUM and LTSS-PARTICIPATION.LTSS-ELIGIBILITY-END-DATE is greater than or equal to 'cutover date' then for every record of type LTSS-PARTICIPATION, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys and (Max(LTSS-PARTICIPATION.LTSS-ELIGIBILITY-EFF-DATE , 'cutover date')) is greater than or equal to PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and LTSS-PARTICIPATION.LTSS-ELIGIBILITY-END-DATE is less than or equal to PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE
04/22/2022	3.0.0	RULE-2990	UPDATE	Data Dictionary - Validation Rules	if PROV-AFFILIATED-PROGRAMS.AFFILIATED-PROGRAM-TYPE equals '2', then for every record of type PROV-AFFILIATED-PROGRAMS, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys	if PROV-AFFILIATED-PROGRAMS.AFFILIATED-PROGRAM-TYPE equals '2',and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-END-DATE is greater than or equal to 'cutover date', then for every record of type PROV-AFFILIATED-PROGRAMS, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and (Max(PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-EFF-DATE, 'cutover date')) is greater than or equal to MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-END-DATE is less than or equal to MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE
04/22/2022	3.0.0	RULE-3061	UPDATE	Data Dictionary - Validation Rules	if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for INSURANCE-COVERAGE-END-DATE, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'	if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null and not invalidly formatted value for DATE-OF-DEATH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to 'cutover date' and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a non-null value for INSURANCE-COVERAGE-END-DATE, then for every record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY, there must be a valid record of type TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO that matches on the join keys and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH and (MAX(PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE, 'cutover date') is greater than or equal to TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE <= TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-END-DATE)
06/24/2022	3.0.0	Rule-6703	UPDATE	Data Dictionary - Validation Rules	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 Value must be compatible with specified T-MSIS picture format: X(4)	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 Value must be compatible with specified T-MSIS picture format: X(5)
06/24/2022	3.0.0	Rule-832	UPDATE	Data Dictionary - Validation Rules	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 Value must be compatible with specified T-MSIS picture format: S9(6)V999	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 Value must be compatible with specified T-MSIS picture format: S9(8)V999
06/24/2022	3.0.0	CIP107	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP107\|ALLOWED-CHARGE-SRC	N/A
06/24/2022	3.0.0	CIP071	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP071\|PROCEDURE-CODE-MOD-1	N/A
06/24/2022	3.0.0	CIP075	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP075\|PROCEDURE-CODE-MOD-2	N/A
06/24/2022	3.0.0	CIP079	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP079\|PROCEDURE-CODE-MOD-3	N/A
06/24/2022	3.0.0	CIP083	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP083\|PROCEDURE-CODE-MOD-4	N/A
06/24/2022	3.0.0	CIP087	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP087\|PROCEDURE-CODE-MOD-5	N/A
06/24/2022	3.0.0	CIP091	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP091\|PROCEDURE-CODE-MOD-6	N/A
06/24/2022	3.0.0	CIP193	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP193\|REFERRING-PROV-SPECIALTY	N/A
06/24/2022	3.0.0	CIP191	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP191\|REFERRING-PROV-TAXONOMY	N/A
06/24/2022	3.0.0	CIP192	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP192\|REFERRING-PROV-TYPE	N/A
06/24/2022	3.0.0	CIP224	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP224\|UNDER-DIRECTION-OF-PROV-NPI	N/A
06/24/2022	3.0.0	CIP225	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP225\|UNDER-DIRECTION-OF-PROV-TAXONOMY	N/A
06/24/2022	3.0.0	CIP226	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP226\|UNDER-SUPERVISION-OF-PROV-NPI	N/A
06/24/2022	3.0.0	CIP227	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP227\|UNDER-SUPERVISION-OF-PROV-TAXONOMY	N/A
06/24/2022	3.0.0	CIP131	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP131\|NATIONAL-HEALTH-CARE-ENTITY-ID	N/A
06/24/2022	3.0.0	CIP201	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP201\|BMI	N/A
06/24/2022	3.0.0	CIP115	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP115\|TOT-COPAY-AMT	N/A
06/24/2022	3.0.0	CIP253	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP253\|TPL-AMT	N/A
06/24/2022	3.0.0	CIP262	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CIP262\|SERVICING-PROV-TAXONOMY	N/A
06/24/2022	3.0.0	CIP208	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CIP208\|BENEFICIARY-COPAYMENT-AMOUNT\|The amount of money the beneficiary paid towards a co-payment.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CIP208\|TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT\|The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on the claim. Do not include copayment payments made by a third party/ies on behalf of the beneficiary.
06/24/2022	3.0.0	CIP206	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CIP206\|BENEFICIARY-COINSURANCE-AMOUNT\|The amount of money the beneficiary paid towards coinsurance.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CIP206\|TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT\|The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their coinsurance for the covered services on the claim. Do not include coinsurance payments made by a third party/ies on behalf of the beneficiary.
06/24/2022	3.0.0	CIP210	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CIP210\|BENEFICIARY-DEDUCTIBLE-AMOUNT\|The amount of money the beneficiary paid towards an annual deductible.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CIP210\|TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT\|The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their deductible for the covered services on the claim. Do not include deductible payments made by a third party/ies on behalf of the beneficiary.
06/24/2022	3.0.0	CIP249	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT CIP249\|IP-LT-QUANTITY-OF-SERVICE-ACTUAL\|For use with CLAIMIP and CLAIMLT claims. For CLAIMOT and CLAIMRX claims/encounter records, use the OT-RX-CLAIM-QUANTITY-ACTUAL field	\|DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT CIP249\|REVENUE-CENTER-QUANTITY-ACTUAL\|For use with CLAIMIP and CLAIMLT claims. For CLAIMOT claims/encounter records use SERVICE-QUANTITY-ACTUAL and CLAIMRX claims/encounter records use the PRESCRIPTION-QUANTITY-ACTUAL field\|
06/24/2022	3.0.0	CIP250	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT CIP250\|IP-LT-QUANTITY-OF-SERVICE-ALLOWED\|	\|DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT CIP250\|REVENUE-CENTER-QUANTITY-ALLOWED\|For use with CLAIMIP and CLAIMLT claims. For CLAIMOT claims/encounter records use SERVICE-QUANTITY-ACTUAL and CLAIMRX claims/encounter records use the PRESCRIPTION-QUANTITY-ACTUAL field
06/24/2022	3.0.0	CIP290	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CIP290\|BEGINNING-DATE-OF-SERVICE\|Mandatory\|For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, this would be the date on which the service covered by this claim began. For capitation premium payments, the date on which the period of coverage related to this payment began. For financial transactions reported to the OT file, populate with the first day of the time period covered by this financial transaction.\|Value must be 8 characters in the form "CCYYMMDD" The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st) When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated End of Time Period value Value must be less than or equal to associated Ending Date of Service value When Type of Claim is not in ['2', '4', 'B', 'D', 'V'] value must be less than or equal to associated Adjudication Date value Value must be less than or equal to associated Date of Death (ELG.002.025) value when populated Value must be less than or equal to at least one of the eligible's Enrollment End Date (ELG.021.254) values \|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002
06/24/2022	3.0.0	CIP295	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CIP295\|COMBINED-BENE-COST-SHARING-PAID-AMOUNT\|Conditional\|The combined amounts the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment, coinsurance, and/or deductible for the covered services on the claim. Only report this data element when the claim does not differentiate among copayment, coinsurance, and/or deductible payments made by the beneficiary. Do not include beneficiary cost sharing payments made by a third party/ies on behalf of the beneficiary.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002
06/24/2022	3.0.0	CIP293	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CIP293\|TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT\|Conditional\|The total coinsurance amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary coinsurance liability for covered services on the claim. Do not subtract out any payments made toward the coinsurance.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002
06/24/2022	3.0.0	CRX164	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX164\|TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT\|Conditional\|The total coinsurance amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary coinsurance liability for covered services on the claim. Do not subtract out any payments made toward the coinsurance.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002
06/24/2022	3.0.0	CIP292	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CIP292\|TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT \|Conditional\|The total copayment amount on a claim that the beneficiary is obligated to pay for covered services. This is the total Medicaid or contract negotiated beneficiary copayment liability for covered service on the claim. Do not subtract out any payments made toward the copayment.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002
06/24/2022	3.0.0	CIP294	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CIP294\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|Conditional\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMIP\|CLAIM-HEADER-RECORD-IP-CIP00002
06/24/2022	3.0.0	CIP296	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CIP296\|IHS-SERVICE-IND\|Mandatory\|To indicate Services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes.\|Value must be 1 character Value must be in [0, 1] or not populated\|CLAIMIP\|CLAIM-LINE-RECORD-IP-CIP00003
01/28/2022	3.0.0	N/A	UPDATE	Data Dictionary - Valid Values	PROV-TAXONOMY.psv v20.1 07/01/2020	PROV-TAXONOMY.psv v22.0 - 01/01/2022
06/24/2022	3.0.0	SSI-IND	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\|DEFINITION\|CODING REQUIREMENT ELG090\|SSI-IND\| A flag indicating if the individual receives Supplemental Security Income (SSI) administered via the Social Security Administration (SSA).\| 1.(LV) value must be in SSI Indicator List (VVL) 2.(S) value must be 1 character 3.(N) conditional 4.(FD1) value must equal '0' when SSI Status equals '003' or is not populated\|	DE NO\|DATA ELEMENT NAME\|DEFINITION\|CODING REQUIREMENT ELG090\|SSI-IND\| A flag indicating if the individual receives Supplemental Security Income (SSI) administered via the Social Security Administration (SSA).\|1.(GS) value must satisfy the requirements of Boolean (DT) 2.(LV) value must be in SSI Indicator List (VVL) 3.(S) value must be 1 character 4.(N) conditional 5.(FD1) value must equal '0' when SSI status (ELG.005.092) equals '000' or '003' or is not populated 6.(FD1) value must equal '1' when SSI status (ELG.005.092) equals '001' or '002'\|
06/24/2022	3.0.0	SSI-STATE-SUPPLEMENT-STATUS-CODE	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG091\|SSI-STATE-SUPPLEMENT-STATUS-CODE\|Indicates the individual's State Supplemental Income Status.\| 1.(LV) value must be in SSI State Supplement Status Code List (VVL) 2.(FD1) (individual not receiving Federal SSI) If SSI State Supplemental Status Code is "001" or "002", then SSI Status cannot be "000" or "003" 3.(S) value must be 3 characters 4.(N) conditional 5.(FD1) value must not be populated when SSI Status is not populated	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG091\|SSI-STATE-SUPPLEMENT-STATUS-CODE\|Indicates the individual's State Supplemental Income Status.\| 1.(LV) value must be in SSI State Supplement Status Code List (VVL) 2.(S) value must be 3 characters 3.(FD1) (individual not receiving Federal SSI)If value is "001" or "002", then SSI Status (ELG.005.092) must be "001" or "002" 4.(FD1) (Individual not receiving Federal SSI)If value is "001" or "002", then SSI Indicator (ELG.005.090) must be '1' 5.(FD1) value must not be populated or must be '000' when SSI Status (ELG.005.092) is not populated or is '000'
06/24/2022	3.0.0	SSI-STATUS	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG092\|SSI-STATUS\|Indicates the individual's SSI Status.\|1.(LV) value must be in SSI Status List (VVL) 2.(S) value must be 3 characters 3.(N) conditional 4.(FD1) value must be populated when SSI Indicator equals '1'	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG092\|SSI-STATUS\|Indicates the individual's SSI Status.\|1.(LV) value must be in SSI Status List (VVL) 2.(S) value must be 3 characters 3.(N) conditional 4.(FD1) when value is '001' or '002', then SSI Indicator must be '1' 5. (FD1) when value is '000' or '003' or not populate, then SSI Indicator must be '0'
06/24/2022	3.0.0	TOT-COPAY-AMT	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CIP115\|TOT-COPAY-AMT\|The total amount paid by Medicaid/CHIP enrollee for each office or emergency department visit or purchase of prescription drugs in addition to the amount paid by Medicaid/CHIP. 1.(GS) value must satisfy the requirements of Total Medicare Deductible Amount (CE)	\|DE No\|Data Element Name\|Definition\| \|CIP115\|TOT-COPAY-AMT\|The total amount paid by Medicaid/CHIP enrollee towards a copayment for the service. 1.(GS) value must satisfy the requirements of Total Copayment Amount (CE)
06/24/2022	3.0.0	MEDICARE-DEDUCTIBLE-AMT	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| CRX127\|MEDICARE-DEDUCTIBLE-AMT\| The amount paid by Medicaid/CHIP on this claim at the claim line level toward the beneficiary's Medicare deductible. If the Medicare deductible amount can be identified separately from Medicare coinsurance payments, code that amount in this field. If the Medicare coinsurance and deductible payments cannot be separated, fill this field with the combined payment amount and MEDICARE-COINSURANCE-PAYMENT is not required.\| 1.(GS) value must satisfy the requirements of US Dollar Amount (DT) 2.(N) conditional The amount paid by Medicaid/CHIP on this claim at the claim line level toward the beneficiary's Medicare deductible. If the Medicare deductible amount can be identified separately from Medicare coinsurance payments, code that amount in this field. If the Medicare coinsurance and deductible payments cannot be separated, fill this field with the combined payment amount and MEDICARE-COINSURANCE-PAYMENT is not required. see US Dollar Amount (TMSIS.DT.000.008)	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| CRX127\|MEDICARE-DEDUCTIBLE-AMT\| The amount paid by Medicaid/CHIP on this claim at the claim line level toward the beneficiary's Medicare deductible. If the Medicare deductible amount can be identified separately from Medicare coinsurance payments, code that amount in this field. If the Medicare coinsurance and deductible payments cannot be separated, fill this field with the combined payment amount and Medicare Coinsurance Payment is not required.\| 1.(GS) value must satisfy the requirements of US Dollar Amount (DT) 2.(N) conditional 3.(FD1) value should not be populated if associated Crossover Indicator value
06/24/2022	3.0.0	MEDICARE-COINS-AMT	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\|DEFINITION\|CODING REQUIREMENT\| CRX128\|MEDICARE-COINS-AMT\|The amount paid by Medicaid/CHIP on this claim toward the recipient's Medicare coinsurance at the claim detail level. If the Medicare coinsurance amount can be identified separately from Medicare deductible payments, code that amount in this field. If Medicare coinsurance and deductible payments cannot be separated, populate the MEDICARE-DEDUCTIBLE-AMT. See US Dollar Amount (DT)\| 1.Value must be between -99999999999.99 and 99999999999.99 2.Value must be expressed as a number with 2-digit precision (e.g. 100.50 ) 3.(payments can't be separated) value 99998 is an exception to the US Dollar Amount requirements 4.(N) conditional	DE NO\|DATA ELEMENT NAME\|DEFINITION\|CODING REQUIREMENT\| CRX128\|MEDICARE-COINS-AMT\|The amount paid by Medicaid/CHIP on this claim toward the recipient's Medicare coinsurance at the claim detail level. If the Medicare coinsurance amount can be identified separately from Medicare deductible payments, code that amount in this field. If Medicare coinsurance and deductible payments cannot be separated, populate the Medicare Deductible Amount.\| 1. Value must be between -99999999999.99 and 99999999999.99 2. if associated Medicare Combined Deductible Indicator is '1', then value must not be populated (or must be 99998) 3. Value must be expressed as a number with 2-digit precision (e.g. 100.50 ) 4. Value must not be populated if Medicare Deductible Amount is not populated 5. Conditional
06/24/2022	3.0.0	DISPENSE-FEE	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| CRX141\|DISPENSE-FEE\|The charge to cover the cost of dispensing the prescription. Dispensing costs include overhead, supplies, and labor, etc. to fill the prescription. Dispense Fee reflects the amount billed by the provider towards the professional dispensing fee. If the provider does not break out the professional dispensing fee on the NCPDP transaction, this field should be left blank in T-MSIS. There is currently no specific field in T-MSIS to capture either the professional dispensing fee amount paid, or the amount billed or paid towards ingredient costs.\| 1.(S) value may include up to 6 digits to the left of the decimal point, and 3 digits to the right e.g. 123456.789 2.(N) mandatory	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| CRX141\|DISPENSE-FEE\|The charge to cover the cost of dispensing the prescription. Dispensing costs include overhead, supplies, and labor, etc. to fill the prescription. Dispense Fee reflects the amount billed by the provider towards the professional dispensing fee. If the provider does not break out the professional dispensing fee on the NCPDP transaction, this field should be left blank in T-MSIS. 1.(LVR) value must be between -99999999999.99 and 99999999999.99 2.(S) value must be expressed as a number with 2-digit precision (e.g. 100.50 ) 3.(S) value may include up to 6 digits to the left of the decimal point, and 3 digits to the right e.g. 123456.78 4.(N) mandatory
06/24/2022	3.0.0	PRIMARY-LANGUAGE-ENGL-PROF-CODE	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG045\|PRIMARY-LANGUAGE-ENGL-PROF-CODE	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG045\|ENGL-PROF-CODE
06/24/2022	3.0.0	LEVEL-OF-CARE-STATUS	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG088\|LEVEL-OF-CARE-STATUS\|\| 1. Value must be in Level of Care Status List (VVL) 2. Value must be 3 characters 3. Conditional	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG088\|LEVEL-OF-CARE-STATUS\|\| 1. Value must be in Level of Care Status List (VVL) 2. Value must be 3 characters 3. Mandatory
06/24/2022	3.0.0	LOCKIN-PROV-NUM	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG140\|LOCKIN-PROV-NUM\| The State-specific Medicaid Provider Identifier is a state-assigned unique identifier that states should report with all individual providers, practice groups, facilities, and other entities. This should be the identifier that is used in the state's Medicaid Management Information System.\| 1.Value must be 30 characters or less 2.Value must be reported in Provider Identifier (PRV.005.080) with an associated Provider Identifier Type (PRV.005.081) equal to '1' 3.(N) mandatory 4.(DI) value must match Provider Identifier (PRV.005.081)	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG140\|LOCKIN-PROV-NUM\| The State-specific Medicaid Provider Identifier is a state-assigned unique identifier that states should report with all individual providers, practice groups, facilities, and other entities. This should be the identifier that is used in the state's Medicaid Management Information System.\| 1.Value must be 30 characters or less 2.(N) mandatory
06/24/2022	3.0.0	LOCKIN-PROV-TYPE	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG141\|LOCKIN-PROV-TYPE\|\| 1.(LV) value must be in Lockin Provider Type List (VVL) 2.Value must be 2 characters 3.Mandatory	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG141\|LOCKIN-PROV-TYPE\|\| 1.(LV) value must be in Provider Type Code List (VVL) 2.Value must be 2 characters 3.Mandatory
06/24/2022	3.0.0	MFP-REASON-PARTICIPATION-ENDED	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG153\|MFP-REASON-PARTICIPATION-ENDED\| A code describing why an individual's participation in Money Follows the Person demonstration ended.\| 1. (LV) value must be in MFP Reason Participation Ended List (VVL) 2.(S) value must be 2 characters 3.(N) conditional 4.(FD1) value must not be populated when Enrollment End Date equals '9999-12-31'	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG153\|MFP-REASON-PARTICIPATION-ENDED\| A code describing why an individual's participation in Money Follows the Person demonstration ended. 1. (LV) value must be in MFP Reason Participation Ended List (VVL) 2.(S) value must be 2 characters 3.(N) conditional 4.(FD1) value must not be populated when Enrollment End Date equals '9999-12-31' 5.(FD1) value must be populated when Enrollment End Date does not equal '9999-12-31'
06/24/2022	3.0.0	LTSS-LEVEL-CARE	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG182\|LTSS-LEVEL-CARE\|\| 1.(LV) value must be in LTSS Level Care List (VVL)\|	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG182\|LTSS-LEVEL-CARE\|\| 1.(LV) value must be in LTSS Level of Care List (VVL)\|
06/24/2022	3.0.0	LTSS-PROV-NUM	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG183\|LTSS-PROV-NUM\| A unique identification number assigned by the state to the long term care facility furnishing healthcare services to the individual.\| 1.Value must be 30 characters or less 2. Value must be reported in Provider Identifier (PRV.005.080) with an associated Provider Identifier Type (PRV.005.081) equal to '1' 3.(N) mandatory 4.(DI) value must match Provider Identifier (PRV.005.081)\|	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| ELG183\|LTSS-PROV-NUM\|A unique identification number assigned by the state to the long term care facility furnishing healthcare services to the individual.\| 1.Value must be 30 characters or less 2.(N) mandatory\|
06/24/2022	3.0.0	DATE-OF-BIRTH	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| PRV034\|DATE-OF-BIRTH\|An individual's date of birth.\| 1.Value must be 8 characters in the form "CCYYMMDD" 2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st) 3. (FD1) value must be less than or equal to associated End of Time Period (PRV.001.010) 4. (FD1) value must be less than or equal to associated Date File Created (PRV.001.008) 5. (N) conditional 6. (FDN) the difference between current value and Start of Time Period (PRV.001.009) must be between 18 and 85 years\|	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| PRV034\|DATE-OF-BIRTH\|An individual's date of birth.\| 1.Value must be 8 characters in the form "CCYYMMDD" 2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st) 3.(FD1) value must be less than or equal to associated End of Time Period (PRV.001.010) 4.(N) conditional 5.(FDN) the difference between current value and Start of Time Period (PRV.001.009) must be between 18 and 85 years\|
06/24/2022	3.0.0	POLICY-OWNER-FIRST-NAME	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| TPL044\|POLICY-OWNER-FIRST-NAME\|Individual's first name; first name component of full name (e.g. First Name, Middle Initial, Last Name).\| 1.Value must be 30 characters or less 2. Value must not contain a pipe or asterisk symbols 3.(FD1) if TPL Health Insurance Coverage Indicator (TPL.002.020) equals "1", then value is mandatory\|	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| TPL044\|POLICY-OWNER-FIRST-NAME\|Individual's first name; first name component of full name (e.g. First Name, Middle Initial, Last Name).\| 1.Value must be 30 characters or less 2. Value must not contain a pipe or asterisk symbols 3.(N) Mandatory\|
06/24/2022	3.0.0	POLICY-OWNER-LAST-NAME	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| TPL045\|POLICY-OWNER-LAST-NAME\|Individual's last name; last name component of full name (e.g. First Name, Middle Initial, Last Name). 1.Value must be 30 characters or less 2. Value must not contain a pipe or asterisk symbols 3.(N) Mandatory	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| TPL045\|POLICY-OWNER-LAST-NAME\|Individual's last name; last name component of full name (e.g. First Name, Middle Initial, Last Name). 1.Value must be 30 characters or less 2. Value must not contain a pipe or asterisk symbols 3.(FD1) if TPL Health Insurance Coverage Indicator (TPL.002.020) equals "1", then value is mandatory
06/24/2022	3.0.0	TYPE-OF-OTHER-THIRD-PARTY-LIABILITY	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| TPL067\|TYPE-OF-OTHER-THIRD-PARTY-LIABILITY\|This code identifies the other types of liabilities an individual may have which are not necessarily defined as a health insurance plan listed INSURANCE-TYPE-PLAN.\| 1.(FDN) If value equals "Other". then Policy Owner (TPL.003.044-047) information is not required 2.(S) value must be 1 character 3.(LV) value must be in Type of Other Third Party Liability List (VVL) 4.(N) mandatory	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| TPL067 \|TYPE-OF-OTHER-THIRD-PARTY-LIABILITY\|This code identifies the other types of liabilities an individual may have which are not necessarily defined as a health insurance plan listed Insurance Type Plan.\| 1.(S) value must be 1 character 2.(LV) value must be in Type of Other Third Party Liability List (VVL) 3.(N) mandatory
06/24/2022	3.0.0	IP-LT-QUANTITY-OF-SERVICE-ALLOWED	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| CIP250\|IP-LT-QUANTITY-OF-SERVICE-ALLOWED\|On facility claim entries, this field is to capture maximum allowable quantity by revenue code category, e.g., number of days in a particular type of accommodation, pints of blood, etc. However, when HCPCS codes are required for services, the units are equal to the number of times the procedure/service being reported was performed.\|	\|DE No\|Data Element Name\|Definition\| CIP250\|IP-LT-QUANTITY-OF-SERVICE-ALLOWED\| On facility claim entries, this field is to capture maximum allowable quantity by revenue code category, e.g., number of days in a particular type of accommodation, pints of blood, etc. However, when HCPCS codes are required for services, the units are equal to the number of times the procedure/service being reported was performed. This field is only applicable when the service being billed can be quantified in discrete units, e.g., a number of visits or the number of units of a prescription/refill that were filled.\|
06/24/2022	3.0.0	COMPOUND-DRUG-IND	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\|DEFINITION\|CODING REQUIREMENT\| CRX086\|COMPOUND-DRUG-IND\|Indicator to specify if the drug is compound or not. see Compound Drug Indicator List (VVL.038)\| 1.(LV) value must be in Compound Drug Indicator List (VVL) 2.(S) value must be 1 character 3.(N) conditional	DE NO\|DATA ELEMENT NAME\|DEFINITION\|CODING REQUIREMENT\| CRX086\|COMPOUND-DRUG-IND Indicator to specify if the drug is compound or not.\| 1.(S) value must be 1 character 2.(LV) value must be in [0, 1] or not populated 3.(LV) value must be in Compound Drug Indicator List (VVL) 4.(N) conditional
06/24/2022	3.0.0	ADMITTING-DIAGNOSIS-CODE	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| CLT027\|ADMITTING-DIAGNOSIS-CODE\|ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as "2105". 1.(GS) value must satisfy the requirements of Diagnosis Code (CE)\|	\|DE No\|Data Element Name\|Definition\| CLT.027\|ADMITTING-DIAGNOSIS-CODE\|The ICD-9/10-CM Diagnosis Code provided at the time of admission by the physician. 1.(GS) value must satisfy the requirements of Diagnosis Code (CE)\|
06/24/2022	3.0.0	DATE-OF-BIRTH	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| CLT126\|DATE-OF-BIRTH\| An individual's date of birth.\| 1.Value must be 8 characters in the form "CCYYMMDD" 2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st) 3.(N) mandatory 4.(FD) value must equal Date of Birth (ELG.002.024) when Conception to Birth Indicator (ELG.005.094) does not equal '1' and Eligibility Group (ELG.005.087) does not equal '64'\|	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| CLT126\|DATE-OF-BIRTH\| An individual's date of birth.\| Description: An individual's date of birth. 1.Value must be 8 characters in the form "CCYYMMDD" 2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st) 3.(N) mandatory\|
06/24/2022	3.0.0	ADMISSION-HOUR	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| CLT045\|ADMISSION-HOUR \|The time of admission to a psychiatric or long-term care facility.\| 1.(LV) value must be in Hour List (VVL) 2.(S) value must be 2 characters 3.(N) conditional\|	DE NO\|DATA ELEMENT NAME\| DEFINITION\|CODING REQUIREMENT\| CLT045\|ADMISSION-HOUR \|The time of admission to a psychiatric or long-term care facility.\| 1.(LV) value must be in Hour List (VVL) 2.(S) value must be 2 characters 3.(N) conditional 4.(FD1) when populated, Admission Date (CLT.002.044) must be populated\|
01/28/2022	3.0.0	ELG095	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|ELG095\|ELIGIBILITY-CHANGE-REASON\|The reason for a change in an individual's eligibility status. Report this reason when there is a change in the individual's eligibility status.\|	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|ELG095\|ELIGIBILITY-CHANGE-REASON\|The reason for a change in an individual's eligibility status. The end date of the segment in which the value is reported must represent the date that the change occurred. The reason for change represents the reason that the segment in which it was reported was closed.\|
06/24/2022	3.0.0	ELG108	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| ELG108\|HEALTH-HOME-ENTITY-NAME\|A field to identify the health home SPA in which an individual is enrolled. Because an identification numbering schema has not been established, the entities' names are being used instead.\| 1.(S) value must 100 characters or less 2.(IV) value must not contain a pipe symbol 3.(N) mandatory\|	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| ELG108\|HEALTH-HOME-ENTITY-NAME\|A field to identify the health home SPA in which an individual is enrolled. Because an identification numbering schema has not been established, the entities' names are being used instead.\| 1.(GS) value must satisfy the requirements of Health Home Entity Name (CE) 2.(S) value must 100 characters or less 3.(N) mandatory\|
06/24/2022	3.0.0	HEALTH-HOME-ENTITY-EFF-DATE	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\|CODING REQUIREMENT\| ELG111\|HEALTH-HOME-ENTITY-EFF-DATE\|The date on which the health home entity was approved by CMS to participate in the Health Home Program.\| 1.(GS) value must satisfy the requirements of Date (DT)	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| ELG111\|HEALTH-HOME-ENTITY-EFF-DATE\|The date on which the health home entity was approved by CMS to participate in the Health Home Program.\| 1.(GS) value must satisfy the requirements of Health Home Entity Effective Date (CE)
06/24/2022	3.0.0	ELG119	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| ELG119\|HEALTH-HOME-ENTITY-NAME\| A field to identify the health home SPA in which an individual is enrolled. Because an identification numbering schema has not been established, the entities' names are being used instead.\| 1.(S) value must 100 characters or less 2.(IV) value must not contain a pipe symbol 3.(N) mandatory	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| ELG119\|HEALTH-HOME-ENTITY-NAME\| A field to identify the health home SPA in which an individual is enrolled. Because an identification numbering schema has not been established, the entities' names are being used instead.\| 1.(GS) value must satisfy the requirements of Health Home Entity Name (CE) 2.(S) value must 100 characters or less 3.(N) mandatory
06/24/2022	3.0.0	HEALTH-HOME-ENTITY-EFF-DATE	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| ELG123\|HEALTH-HOME-ENTITY-EFF-DATE\|The date on which the health home entity was approved by CMS to participate in the Health Home Program.\| 1.Value must be 8 characters in the form "CCYYMMDD" 2.(LV) the date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st) 2.(N) mandatory	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| ELG123\|HEALTH-HOME-ENTITY-EFF-DATE\|The date on which the health home entity was approved by CMS to participate in the Health Home Program.\| 1.(S) value must be 8 characters in the form 'YYYYMMDD' 2.(LV) the date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st) 3.(N) mandatory
06/24/2022	3.0.0	PROV-LOCATION-ID	UPDATE	Data Dictionary	DE No\|Data Element Name\| CODING REQUIREMENT\| PRV043\|PROV-LOCATION-ID\| 1.(IV) value must not contain a pipe symbol 2.(S) value must be 5 characters or less	DE No\|Data Element Name\| CODING REQUIREMENT\| PRV043\|PROV-LOCATION-ID\| 1. (IV) value must not contain a pipe or asterisk symbols 2. (S) value must be 5 characters or less 3. (N) mandatory
06/24/2022	3.0.0	PROV-LOCATION-ID	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| PRV064\|PROV-LOCATION-ID\|\| 1.(IV) value must not contain a pipe symbol 2.(S) value must be 5 characters or less	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| PRV064\|PROV-LOCATION-ID\|\| 1. (IV) value must not contain a pipe or asterisk symbols 2. (S) value must be 5 characters or less 3. (N) mandatory
06/24/2022	3.0.0	PROV-LOCATION-ID	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| PRV.076\|PROV-LOCATION-ID\|\| 1.(IV) value must not contain a pipe symbol 2.(S) value must be 5 characters or less	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| PRV.076\|PROV-LOCATION-ID\|\| 1. (IV) value must not contain a pipe or asterisk symbols 2. (S) value must be 5 characters or less 3. (N) mandatory
06/24/2022	3.0.0	PROV-LOCATION-ID	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| PRV129\|PROV-LOCATION-ID\|\| 1.(IV) value must not contain a pipe symbol 2.(S) value must be 5 characters or less	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| PRV129\|PROV-LOCATION-ID\|\| 1. (IV) value must not contain a pipe or asterisk symbols 2. (S) value must be 5 characters or less 3. (N) mandatory
06/24/2022	3.0.0	NON-COV-DAYS	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CIP134\|NON-COV-DAYS\|The number of days of inpatient care not covered by the payer for this sequence as qualified by the payer organization. The number of non-covered days does not refer to days not covered for any other service. 1.Value must be a positive integer 2.Value must be between 0:99999999999 (inclusive) 3.Conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CIP134\|NON-COV-DAYS\|The number of days of inpatient care not covered by the payer for this sequence as qualified by the payer organization. The number of non-covered days does not refer to days not covered for any other service. 1. (S) value must be 5 digits or less 2.(N) conditional
06/24/2022	3.0.0	CIP214	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CIP214\|HEALTH-HOME-ENTITY-NAME\|\| 1.Value must 50 characters or less 2.Value must not contain a pipe or asterisk symbols 3.Conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CIP214\|HEALTH-HOME-ENTITY-NAME\|\| 1.1.(IV) value must not contain a pipe or asterisk symbols 2.(S) value must 50 characters or less 3.(N) conditional
06/24/2022	3.0.0	COT138	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| COT138\|HEALTH-HOME-ENTITY-NAME\|\| 1.Value must 50 characters or less 2.Value must not contain a pipe or asterisk symbols 3.Conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| COT138\|HEALTH-HOME-ENTITY-NAME\|\| 1.1.(IV) value must not contain a pipe or asterisk symbols 2.(S) value must 50 characters or less 3.(N) conditional
06/24/2022	3.0.0	CRX096	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CRX.096\|HEALTH-HOME-ENTITY-NAME\|\| 1.(GS) value must satisfy the requirements of Health Home Entity Name (CE)	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CRX.096\|HEALTH-HOME-ENTITY-NAME\|\| 1.(GS) value must satisfy the requirements of Health Home Entity Name (CE) 2.(S) value must 50 characters or less 3.(N) conditional
06/24/2022	3.0.0	NON-COV-DAYS	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CLT084\|NON-COV-DAYS\|\| 1.(GS) value must satisfy the requirements of Non-Covered Days (CE) 2.(S) value must be 5 digits or less	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CLT084\|NON-COV-DAYS\|\| 1.(GS) value must satisfy the requirements of Non-Covered Days (CE)
06/24/2022	3.0.0	CLT161	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CLT.161\|HEALTH-HOME-ENTITY-NAME\|\| 1.(GS) value must satisfy the requirements of Health Home Entity Name (CE)	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CLT.161\|HEALTH-HOME-ENTITY-NAME\|\| 1.(GS) value must satisfy the requirements of Health Home Entity Name (CE) 2.(S) value must 50 characters or less 3.(N) conditional
06/24/2022	3.0.0	MARITAL-STATUS-OTHER-EXPLANATION	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| ELG035\|MARITAL-STATUS-OTHER-EXPLANATION\|\| 1.(FD1) if associated Marital Status (ELG.003.035) equals '14' (Other), then value is mandatory and must be provided 2.(S) value must be 50 characters or less 3.(N) conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| ELG035\|MARITAL-STATUS-OTHER-EXPLANATION\|\| 1.(FD1) if associated Marital Status (ELG.003.035) equals '14' (Other), then value is mandatory and must be provided 2.(S) value must be 50 characters or less 3.(IV) value must not contain a pipe or asterisk symbol 4.(N) conditional
06/24/2022	3.0.0	IMMIGRATION-STATUS-FIVE-YEAR-BAR-END-DATE	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| ELG044\|IMMIGRATION-STATUS-FIVE-YEAR-BAR-END-DATE\|\| 1.(GS) value must satisfy the requirements of End Date (CE) 2.(FD1) (U.S. Citizen) if associated Citizenship Indicator (ELG.003.040) value is '1', then value should not be populated 3.(FD1) (Non U.S. Citizen) if associated Citizenship Indicator (ELG.003.040) value is '0', then value should be populated 4.(N) conditional 5.(FD1) (U.S. Citizen) value should not be populated when Immigration Status (ELG.003.042) equals '8'	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| ELG044\|IMMIGRATION-STATUS-FIVE-YEAR-BAR-END-DATE\|\| 1.(GS) value must satisfy the requirements of Date (CE) 2.(N) conditional 3.(FD1) (U.S. Citizen) value should not be populated when Immigration Status (ELG.003.042) equals '8'
06/24/2022	3.0.0	TEACHING-IND	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| PRV027\|TEACHING-IND\|\| 1.(LV) value must be in Teaching Indicator List (VVL) 2.(S) value must be 1 character 3.(N) conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| PRV027\|TEACHING-IND\|\| 1.(LV) value must be in Teaching Indicator List (VVL) 2.(S) value must be 1 character 3. (FD) value must be '0' when Facility Group Individual Code (PRV.002.026) equals '02' or '03' 4.(N) conditional
06/24/2022	3.0.0	TPL-ENTITY-ADDR-TYPE	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| TPL.076\|TPL-ENTITY-ADDR-TYPE\|\| 1.(LV) value must be in TPL Entity Address Type List (VVL) 2.(S) value must be 2 characters 3.(N) conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| TPL.076\|TPL-ENTITY-ADDR-TYPE\|\| 1.(LV) value must be in TPL Entity Address Type List (VVL) 2.(S) value must be 2 characters 3.(N) mandatory
06/24/2022	3.0.0	1115A-DEMONSTRATION-IND	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CIP025\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.223) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CIP025\|1115A-DEMONSTRATION-IND\|In the claims files this data element indicates whether the claim or encounter was covered under the authority of an 1115(A) demonstration. In the Eligibility file, this data element indicates whether the individual participates in an 1115(A) demonstration.\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional 5. Value must be in [0, 1] or not populated
06/24/2022	3.0.0	1115A-DEMONSTRATION-IND	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| COT024\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.223) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| COT024\|1115A-DEMONSTRATION-IND\|In the claims files this data element indicates whether the claim or encounter was covered under the authority of an 1115(A) demonstration. In the Eligibility file, this data element indicates whether the individual participates in an 1115(A) demonstration.\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional 5. Value must be in [0, 1] or not populated
06/24/2022	3.0.0	1115A-DEMONSTRATION-IND	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CRX024\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.223) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CRX024\|1115A-DEMONSTRATION-IND\|In the claims files this data element indicates whether the claim or encounter was covered under the authority of an 1115(A) demonstration. In the Eligibility file, this data element indicates whether the individual participates in an 1115(A) demonstration.\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional 5. Value must be in [0, 1] or not populated
06/24/2022	3.0.0	1115A-DEMONSTRATION-IND	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CLT024\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.223) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CLT024\|1115A-DEMONSTRATION-IND\|In the claims files this data element indicates whether the claim or encounter was covered under the authority of an 1115(A) demonstration. In the Eligibility file, this data element indicates whether the individual participates in an 1115(A) demonstration.\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional 5. Value must be in [0, 1] or not populated
05/13/2022	3.0.0	N/A	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION PROCEDURE-CODE-MOD\|20080101\|20201231\|ED\|Hct>39% or hgb>13g>=3 cycle\|Hematocrit level has exceeded 39% (or hemoglobin level has exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cycle PROCEDURE-CODE-MOD\|20210101\|99991231\|ED\|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Diagnostic or therapeutic site\| PROCEDURE-CODE-MOD\|20080101\|20201231\|EE\|Hct>39% or hgb>13g<3 cycle\|Hematocrit level has not exceeded 39% (or hemoglobin level has not exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cycle PROCEDURE-CODE-MOD\|20210101\|99991231\|EE\|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Residential, domiciliary, custodial facility (other than 1819 facility)\|	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION PROCEDURE-CODE-MOD\|00010101\|20201231\|ED\|Hct>39% or hgb>13g>=3 cycle\|Hematocrit level has exceeded 39% (or hemoglobin level has exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cycle PROCEDURE-CODE-MOD\|20210101\|99991231\|ED\|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Diagnostic or therapeutic site\| PROCEDURE-CODE-MOD\|00010101\|20201231\|EE\|Hct>39% or hgb>13g<3 cycle\|Hematocrit level has not exceeded 39% (or hemoglobin level has not exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cycle PROCEDURE-CODE-MOD\|20210101\|99991231\|EE\|FROM Residential, domiciliary, custodial facility (other than 1819 facility) TO Residential, domiciliary, custodial facility (other than 1819 facility)\|
06/24/2022	3.0.0	CLT239	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CLT239\|TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT\|Conditional\|The total copayment amount on a claim that the beneficiary is obligated to pay for covered services. This is the total Medicaid or contract negotiated beneficiary copayment liability for covered service on the claim. Do not subtract out any payments made toward the copayment.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002
06/24/2022	3.0.0	CLT241	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CLT241\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|Conditional\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002
06/24/2022	3.0.0	CLT139	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CLT139\|REFERRING-PROV-SPECIALTY	N/A
06/24/2022	3.0.0	CLT137	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CLT137\|REFERRING-PROV-TAXONOMY	N/A
06/24/2022	3.0.0	CLT138	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CLT138\|REFERRING-PROV-TYPE	N/A
06/24/2022	3.0.0	CLT214	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CLT214\|SERVICING-PROV-TAXONOMY	N/A
06/24/2022	3.0.0	CLT169	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CLT169\|UNDER-DIRECTION-OF-PROV-NPI	N/A
06/24/2022	3.0.0	CLT170	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CLT170\|UNDER-SUPERVISION-OF-PROV-NPI	N/A
06/24/2022	3.0.0	CLT171	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CLT171\|UNDER-SUPERVISION-OF-PROV-NPI	N/A
06/24/2022	3.0.0	CLT172	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CLT172\|UNDER-SUPERVISION-OF-PROV-TAXONOMY	N/A
06/24/2022	3.0.0	CLT081	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CLT081\|NATIONAL-HEALTH-CARE-ENTITY-ID	N/A
06/24/2022	3.0.0	CLT143	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CLT143\|BMI	N/A
06/24/2022	3.0.0	CLT066	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CLT066\|TOT-COPAY-AMT	N/A
06/24/2022	3.0.0	CLT242	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CLT242\|COMBINED-BENE-COST-SHARING-PAID-AMOUNT\|Conditional\|The combined amounts the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment, coinsurance, and/or deductible for the covered services on the claim. Only report this data element when the claim does not differentiate among copayment, coinsurance, and/or deductible payments made by the beneficiary. Do not include beneficiary cost sharing payments made by a third party/ies on behalf of the beneficiary.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002
06/24/2022	3.0.0	CLT240	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CLT240\|TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT\|Conditional\|The total coinsurance amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary coinsurance liability for covered services on the claim. Do not subtract out any payments made toward the coinsurance.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002
06/24/2022	3.0.0	CLT243	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CLT243\|IHS-SERVICE-IND\|Mandatory\|To indicate Services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes.\|Value must be 1 character Value must be in [0, 1] or not populated\|CLAIMLT\|CLAIM-LINE-RECORD-LT-CLT00003
06/24/2022	3.0.0	Rule-6152	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4)	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(5)
06/24/2022	3.0.0	Rule-6661	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(6)V999	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(8)V999
06/24/2022	3.0.0	CLT155	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CLT155\|BENEFICIARY-COPAYMENT-AMOUNT\|The amount of money the beneficiary paid towards a co-payment.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CLT155\|TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT\|The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on the claim. Do not include copayment payments made by a third party/ies on behalf of the beneficiary.
06/24/2022	3.0.0	CLT153	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CLT153\|BENEFICIARY-COINSURANCE-AMOUNT\|The amount of money the beneficiary paid towards coinsurance.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CLT153\|TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT\|The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their coinsurance for the covered services on the claim. Do not include coinsurance payments made by a third party/ies on behalf of the beneficiary.
06/24/2022	3.0.0	CLT157	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CLT157\|BENEFICIARY-DEDUCTIBLE-AMOUNT\|The amount of money the beneficiary paid towards an annual deductible.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CLT157\|TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT\|The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their deductible for the covered services on the claim. Do not include deductible payments made by a third party/ies on behalf of the beneficiary.
06/24/2022	3.0.0	CLT202	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT CLT202\|IP-LT-QUANTITY-OF-SERVICE-ACTUAL\|For use with CLAIMIP and CLAIMLT claims. For CLAIMOT and CLAIMRX claims/encounter records, use the OT-RX-CLAIM-QUANTITY-ACTUAL field	\|DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT CLT202\|REVENUE-CENTER-QUANTITY-ACTUAL\|For use with CLAIMIP and CLAIMLT claims. For CLAIMOT claims/encounter records use SERVICE-QUANTITY-ACTUAL and CLAIMRX claims/encounter records use the PRESCRIPTION-QUANTITY-ACTUAL field
06/24/2022	3.0.0	CLT203	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT CLT203\|IP-LT-QUANTITY-OF-SERVICE-ALLOWED\|For use with CLAIMIP and CLAIMLT claims. For CLAIMOT and CLAIMRX claims/encounter records, use the OT-RX-CLAIM-QUANTITY-ACTUAL field	\|DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT CLT203\|REVENUE-CENTER-QUANTITY-ALLOWED\|For use with CLAIMIP and CLAIMLT claims. For CLAIMOT claims/encounter records use SERVICE-QUANTITY-ACTUAL and CLAIMRX claims/encounter records use the PRESCRIPTION-QUANTITY-ACTUAL field
06/24/2022	3.0.0	Rule-6900	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(12)	Value must be compatible with specified T-MSIS picture format: X(30)
06/24/2022	3.0.0	Rule-6931	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(12)	Value must be compatible with specified T-MSIS picture format: X(30)
06/24/2022	3.0.0	Rule-7594	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid date of the form CCYYMMDD
06/24/2022	3.0.0	Rule-7595	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid date of the form CCYYMMDD
06/24/2022	3.0.0	Rule-7596	ADD	Data Dictionary - Validation Rules	N/A	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 Value must be compatible with specified T-MSIS picture format: X(1)
06/24/2022	3.0.0	Rule-7610	ADD	Data Dictionary - Validation Rules	N/A	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 field is populated, the value must be contained in the set of valid values with id: 'IHS-SERVICE-IND' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null and 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'
06/24/2022	3.0.0	Rule-7597	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7598	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7599	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7600	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7612	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(30)
06/24/2022	3.0.0	Rule-7613	ADD	Data Dictionary - Validation Rules	N/A	Value must be compatible with specified T-MSIS picture format: X(10)
06/24/2022	3.0.0	Rule-7614	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7615	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7616	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V999
06/24/2022	3.0.0	Rule-7617	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7618	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1)
06/24/2022	3.0.0	RULE-416	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-417	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-1, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-1'	N/A
06/24/2022	3.0.0	RULE-429	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-430	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-2, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-2'	N/A
06/24/2022	3.0.0	RULE-442	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-455	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-456	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-4, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-4'	N/A
06/24/2022	3.0.0	RULE-469	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-470	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-5, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-5'	N/A
06/24/2022	3.0.0	RULE-482	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-483	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-6, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-6'	N/A
06/24/2022	3.0.0	RULE-518	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ALLOWED-CHARGE-SRC' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-537	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99	N/A
06/24/2022	3.0.0	RULE-6150	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12)	N/A
06/24/2022	3.0.0	RULE-6284	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2)	N/A
06/24/2022	3.0.0	RULE-6286	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2)	N/A
06/24/2022	3.0.0	RULE-6287	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2)	N/A
06/24/2022	3.0.0	RULE-6302	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2)	N/A
06/24/2022	3.0.0	RULE-6303	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2)	N/A
06/24/2022	3.0.0	RULE-6304	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2)	N/A
06/24/2022	3.0.0	RULE-6561	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12)	N/A
06/24/2022	3.0.0	RULE-6607	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(10)	N/A
06/24/2022	3.0.0	RULE-6652	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(1)	N/A
06/24/2022	3.0.0	RULE-6707	UPDATE	Data Dictionary - Validation Rules	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 Value must be compatible with specified T-MSIS picture format: X(12)	N/A
06/24/2022	3.0.0	RULE-6826	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12)	N/A
06/24/2022	3.0.0	RULE-6893	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2)	N/A
06/24/2022	3.0.0	RULE-7046	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(10)	N/A
06/24/2022	3.0.0	RULE-705	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-7055	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2)	N/A
06/24/2022	3.0.0	RULE-706	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-707	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-7079	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(10)	N/A
06/24/2022	3.0.0	RULE-720	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: S9(5)V9	N/A
06/24/2022	3.0.0	RULE-751	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for UNDER-DIRECTION-OF-PROV-NPI, then CLAIM-HEADER-RECORD-IP.UNDER-DIRECTION-OF-PROV-NPI is a valid National Provider Identifier (NPI) number'	N/A
06/24/2022	3.0.0	RULE-753	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-754	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for UNDER-SUPERVISION-OF-PROV-NPI, then CLAIM-HEADER-RECORD-IP.UNDER-SUPERVISION-OF-PROV-NPI is a valid National Provider Identifier (NPI) number'	N/A
06/24/2022	3.0.0	RULE-756	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-801	UPDATE	Data Dictionary - Validation Rules	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 Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99	N/A
06/24/2022	3.0.0	RULE-814	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' 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)'	N/A
06/24/2022	3.0.0	COT228	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME COT228\|ORDERING-PROV-NUM\|Conditional\|The Medicaid provider ID of the Ordering Provider is the individual who requested the services or items being reported on this service line. Examples include, but are not limited to, provider ordering diagnostic tests and medical equipment or supplies\|Value must be 30 characters or less\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002
06/24/2022	3.0.0	COT229	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME COT229\|ORDERING-PROV-NPI-NUM\|Conditional\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\|Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002
06/24/2022	3.0.0	COT233	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME COT233\|COMBINED-BENE-COST-SHARING-PAID-AMOUNT\|Conditional\|The combined amounts the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment, coinsurance, and/or deductible for the covered services on the claim. Only report this data element when the claim does not differentiate among copayment, coinsurance, and/or deductible payments made by the beneficiary. Do not include beneficiary cost sharing payments made by a third party/ies on behalf of the beneficiary.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002
06/24/2022	3.0.0	COT231	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME COT231\|TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT\|Conditional\|The total coinsurance amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary coinsurance liability for covered services on the claim. Do not subtract out any payments made toward the coinsurance.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002
06/24/2022	3.0.0	COT230	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME COT230\|TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT\|Conditional\|The total copayment amount on a claim that the beneficiary is obligated to pay for covered services. This is the total Medicaid or contract negotiated beneficiary copayment liability for covered service on the claim. Do not subtract out any payments made toward the copayment.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002
06/24/2022	3.0.0	COT232	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME COT232\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|Conditional\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMOT\|CLAIM-HEADER-RECORD-OT-COT00002
06/24/2022	3.0.0	COT234	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME COT234\|IHS-SERVICE-IND\|Mandatory\|To indicate Services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes.\|Value must be 1 character Value must be in [0, 1] or not populated\|CLAIMOT\|CLAIM-LINE-RECORD-OT-COT00003
09/26/2022	3.0.3	N/A	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION RESTRICTED-BENEFITS-CODE\|20230101\|99991231\|G\|Individual is eligible for Medicaid but only entitled to restricted benefits based on Medicare dual-eligibility status Medicare Part B-ID ESRD Benefit.
06/24/2022	3.0.0	COT144	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME COT144\|DATE-CAPITATED-AMOUNT-REQUESTED	N/A
06/24/2022	3.0.0	COT145	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME COT145\|CAPITATED-PAYMENT-AMT-REQUESTED	N/A
06/24/2022	3.0.0	COT121	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME COT121\|REFERRING-PROV-SPECIALTY	N/A
06/24/2022	3.0.0	COT119	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME COT119\|REFERRING-PROV-TAXONOMY	N/A
06/24/2022	3.0.0	COT120	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME COT120\|REFERRING-PROV-TYPE	N/A
06/24/2022	3.0.0	COT148	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME COT148\|UNDER-DIRECTION-OF-PROV-NPI	N/A
06/24/2022	3.0.0	COT149	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME COT149\|UNDER-DIRECTION-OF-PROV-TAXONOMY	N/A
06/24/2022	3.0.0	COT151	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME COT151\|UNDER-SUPERVISION-OF-PROV-TAXONOMY	N/A
06/24/2022	3.0.0	COT067	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME COT067\|NATIONAL-HEALTH-CARE-ENTITY-ID	N/A
06/24/2022	3.0.0	COT125	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME COT125\|BMI	N/A
06/24/2022	3.0.0	COT220	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME COT220\|HCPCS-RATE	N/A
06/24/2022	3.0.0	COT051	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME COT051\|TOT-COPAY-AMT	N/A
06/24/2022	3.0.0	Rule-1653	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(8)V999
06/24/2022	3.0.0	Rule-1716	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(6)V999	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(8)V999
06/24/2022	3.0.0	Rule-6183	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(8)V999
06/24/2022	3.0.0	Rule-7027	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4)	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(5)
06/24/2022	3.0.0	COT176	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|NECESSITY\|DEFINITION COT176\|COPAY-AMT \|Conditional\|The copayment amount paid by an enrollee for the service, which does not include the amount paid by the insurance company.	\|DE NO\| DATA ELEMENT NAME\|NECESSITY\|DEFINITION COT176\|BENEFICIARY-COPAYMENT-PAID-AMOUNT \|Optional\|The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on a claim line. Do not include copayment payments made by a third party/ies on behalf of the beneficiary. This is a copayment paid for a service in the corresponding claim line for OT and RX claim files. The Beneficiary Copayment Paid Amount is an optional line level data element reported for OT and RX claim file types, only. If the beneficiary copayment paid amount is not available at the claim line level, report the total copayment paid amount in the header level copayment data element.
06/24/2022	3.0.0	CRX167	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX167\|INGREDIENT-COST-SUBMITTED \|Conditional\|The charge to cover the cost of ingredients for the prescription or drug.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003
06/24/2022	3.0.0	CRX168	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX168\|INGREDIENT-COST-PAID-AMT \|Conditional\|The amount paid by Medicaid or the managed care plan on this claim or adjustment at the claim detail level towards the cost of ingredients for the prescription or drug.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003
06/24/2022	3.0.0	CRX169	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX169\|DISPENSE-FEE-PAID-AMT\|Conditional\|The amount paid by Medicaid or the managed care plan on this claim or adjustment towards the cost of the pharmacy's professional dispensing fee for the prescription.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 \|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003
06/24/2022	3.0.0	CRX170	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX170\|PROFESSIONAL-SERVICE-FEE-SUBMITTED\|Conditional\|The charge to cover the clinical services, not otherwise covered under the professional dispensing fee. (Example "not filling a prescription because of therapeutic duplication")\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003
06/24/2022	3.0.0	CRX171	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX171\|PROFESSIONAL-SERVICE-FEE-PAID-AMT\|Conditional\|The amount paid by Medicaid or the managed care plan on this claim or adjustment towards the costs of clinical services not otherwise covered under the professional dispensing fee.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003
06/24/2022	3.0.0	CRX166	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX166\|COMBINED-BENE-COST-SHARING-PAID-AMOUNT\|Conditional\|The combined amounts the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment, coinsurance, and/or deductible for the covered services on the claim. Only report this data element when the claim does not differentiate among copayment, coinsurance, and/or deductible payments made by the beneficiary. Do not include beneficiary cost sharing payments made by a third party/ies on behalf of the beneficiary.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002
06/24/2022	3.0.0	CRX163	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX163\|TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT\|Conditional\|The total copayment amount on a claim that the beneficiary is obligated to pay for covered services. This is the total Medicaid or contract negotiated beneficiary copayment liability for covered service on the claim. Do not subtract out any payments made toward the copayment.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002
06/24/2022	3.0.0	CRX165	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX165\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|Conditional\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002
06/24/2022	3.0.0	CRX172	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX172\|IHS-SERVICE-IND\|Mandatory\|To indicate Services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes.\|Value must be 1 character Value must be in [0, 1] or not populated\|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003
06/24/2022	3.0.0	CRX078	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CRX078\|PRESCRIBING-PROV-SPECIALTY	N/A
06/24/2022	3.0.0	CRX076	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CRX076\|PRESCRIBING-PROV-TAXONOMY	N/A
06/24/2022	3.0.0	CRX077	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CRX077\|PRESCRIBING-PROV-TYPE	N/A
06/24/2022	3.0.0	CRX057	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CRX057\|NATIONAL-HEALTH-CARE-ENTITY-ID	N/A
06/24/2022	3.0.0	CRX103	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CRX103\|DISPENSING-PRESCRIPTION-DRUG-PROV-TAXONOMY	N/A
06/24/2022	3.0.0	CRX042	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME CRX042\|TOT-COPAY-AMT	N/A
06/24/2022	3.0.0	CRX089	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CRX089\|BENEFICIARY-COPAYMENT-AMOUNT\|The amount of money the beneficiary paid towards a co-payment.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CRX089\|TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT\|The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on the claim. Do not include copayment payments made by a third party/ies on behalf of the beneficiary.
06/24/2022	3.0.0	CRX087	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CRX087\|BENEFICIARY-COINSURANCE-AMOUNT\|The amount of money the beneficiary paid towards coinsurance.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CRX087\|TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT\|The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their coinsurance for the covered services on the claim. Do not include coinsurance payments made by a third party/ies on behalf of the beneficiary.
06/24/2022	3.0.0	CRX092	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CRX092\|BENEFICIARY-DEDUCTIBLE-AMOUNT\|The amount of money the beneficiary paid towards an annual deductible.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CRX092\|TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT\|The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their deductible for the covered services on the claim. Do not include deductible payments made by a third party/ies on behalf of the beneficiary.
06/24/2022	3.0.0	CRX123	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|NECESSITY\|DEFINITION CRX123\|COPAY-AMT \|Conditional\|The copayment amount paid by an enrollee for the service, which does not include the amount paid by the insurance company.	\|DE NO\| DATA ELEMENT NAME\|NECESSITY\|DEFINITION CRX123\|BENEFICIARY-COPAYMENT-PAID-AMOUNT\|Optional\|The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on a claim line. Do not include copayment payments made by a third party/ies on behalf of the beneficiary. This is a copayment paid for a service in the corresponding claim line for OT and RX claim files. The Beneficiary Copayment Paid Amount is an optional line level data element reported for OT and RX claim file types, only. If the beneficiary copayment paid amount is not available at the claim line level, report the total copayment paid amount in the header level copayment data element.
06/24/2022	3.0.0	CRX141	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|NECESSITY\|DEFINITION CRX141\|DISPENSE-FEE\|\|The charge to cover the cost of dispensing the prescription. Dispensing costs include overhead, supplies, and labor, etc. to fill the prescription.	\|DE NO\| DATA ELEMENT NAME\|NECESSITY\|DEFINITION CRX141\|DISPENSE-FEE-SUBMITTED \|\|The charge to cover the cost of the professional dispensing fee for the prescription.
06/24/2022	3.0.0	CRX131	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT CRX131\|OT-RX-CLAIM-QUANITY-ALLOWED\|The value in OT-RX-CLAIM-QUANTITY-ALLOWED must correspond with the value in UNIT-OF-MEASURE.	\|DE NO\| DATA ELEMENT NAME\|CODING REQUIREMENT CRX131\|PRESCRIPTION-QUANTITY-ALLOWED\|The value in PRESCRIPTION-QUANTITY-ALLOWED must correspond with the value in UNIT-OF-MEASURE.
06/24/2022	3.0.0	CIP213	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CIP213\|COPAY-WAIVED-IND\|An indicator signifying that the copay was waived by the provider.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CIP213\|COPAY-WAIVED-IND\|An indicator signifying that the copay was discounted or waived by the provider (e.g., physician or hospital). Do not use to indicate administrative-level, Medicaid State Agency or Medicaid MCO copayment waived decisions.
06/24/2022	3.0.0	CLT160	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CLT160\|COPAY-WAIVED-IND\|An indicator signifying that the copay was waived by the provider.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CLT160\|COPAY-WAIVED-IND\|An indicator signifying that the copay was discounted or waived by the provider (e.g., physician or hospital). Do not use to indicate administrative-level, Medicaid State Agency or Medicaid MCO copayment waived decisions.
06/24/2022	3.0.0	COT137	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION COT137\|COPAY-WAIVED-IND\|An indicator signifying that the copay was waived by the provider.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION COT137\|COPAY-WAIVED-IND\|An indicator signifying that the copay was discounted or waived by the provider (e.g., physician or hospital). Do not use to indicate administrative-level, Medicaid State Agency or Medicaid MCO copayment waived decisions.
06/24/2022	3.0.0	CRX095	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CRX095\|COPAY-WAIVED-IND\|An indicator signifying that the copay was waived by the provider.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CRX095\|COPAY-WAIVED-IND\|An indicator signifying that the copay was discounted or waived by the provider (e.g., physician or hospital). Do not use to indicate administrative-level, Medicaid State Agency or Medicaid MCO copayment waived decisions.
06/24/2022	3.0.0	Rule-7605	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7606	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7607	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7608	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7609	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1)
03/11/2022	3.0.0	CIP228	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME\| DEFINITION\| CIP228 \| MEDICARE-PAID-AMT \|The amount paid by Medicare on this claim or adjustment.\|	DE NO\| DATA ELEMENT NAME\| DEFINITION\| CIP228 \| MEDICARE-PAID-AMT \|The amount paid by Medicare on this claim. For claims where Medicare payment is only available at the line level, report the sum of all the line level Medicare payment amounts at the header.\|
03/11/2022	3.0.0	CLT179	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME\| DEFINITION\| CLT179 \| MEDICARE-PAID-AMT \|The amount paid by Medicare on this claim or adjustment.\|	DE NO\| DATA ELEMENT NAME\| DEFINITION\| CLT179 \| MEDICARE-PAID-AMT \|The amount paid by Medicare on this claim. For claims where Medicare payment is only available at the line level, report the sum of all the line level Medicare payment amounts at the header.\|
03/11/2022	3.0.0	COT182	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME\| DEFINITION\| COT182 \| MEDICARE-PAID-AMT \|The amount paid by Medicare on this claim or adjustment.\|	DE NO\| DATA ELEMENT NAME\| DEFINITION\| COT182 \| MEDICARE-PAID-AMT \|The amount paid by Medicare on this claim. For claims where Medicare payment is only available at the header level, report the entire payment amount on the T-MSIS claim line with the highest charge or the 1st non-denied line. Zero fill Medicare Paid Amount on all other claim lines.\|
03/11/2022	3.0.0	CRX129	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME\| DEFINITION\| CRX129 \| MEDICARE-PAID-AMT \|The amount paid by Medicare on this claim or adjustment.\|	DE NO\| DATA ELEMENT NAME\| DEFINITION\| CRX129 \| MEDICARE-PAID-AMT \|The amount paid by Medicare on this claim. For claims where Medicare payment is only available at the header level, report the entire payment amount on the T-MSIS claim line with the highest charge or the 1st non-denied line. Zero fill Medicare Paid Amount on all other claim lines.\|
06/24/2022	3.0.0	Rule-7620	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7621	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7622	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7623	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7624	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7625	ADD	Data Dictionary - Validation Rules	N/A	Value must be compatible with specified T-MSIS picture format: X(1)
06/24/2022	3.0.0	Rule-7626	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7627	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7628	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7629	ADD	Data Dictionary - Validation Rules	N/A	Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
06/24/2022	3.0.0	Rule-7630	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1)
02/18/2022	3.0.0	COT191	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \|CODING REQUIREMENT\| \|COT191\|SERVICING-PROV-TAXONOMY\|[No longer essential - Both data element and associated requirement(s); preserved for file submission integrity. See Data Dictionary v2.3 for specific definition and coding requirement description(s).]\| Conditional\| Not Applicable\|	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \|CODING REQUIREMENT\| \|COT191\| SERVICING-PROV-TAXONOMY\| The taxonomy code for the provider who treated the recipient.\| Conditional \| Value must be equal to a valid value.\| COT191\|SERVICING-PROV-TAXONOMY\|Not Applicable \|Not Applicable \| Leave blank or space-fill field for capitation or premium payments (TYPE-OF-SERVICE = 119, 120, 121, 122)\| COT191\|SERVICING-PROV-TAXONOMY\|Not Applicable\| Not Applicable\| Generally, the provider taxonomy requires 10 bytes. However, two additional bytes have been provided for future expansion.\|
06/24/2022	3.0.0	RULE-1136	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' 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)'	N/A
06/24/2022	3.0.0	RULE-1137	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' 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)'	N/A
06/24/2022	3.0.0	RULE-1138	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' 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)'	N/A
06/24/2022	3.0.0	RULE-1182	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for UNDER-DIRECTION-OF-PROV-NPI, then CLAIM-HEADER-RECORD-LT.UNDER-DIRECTION-OF-PROV-NPI is a valid National Provider Identifier (NPI) number'	N/A
06/24/2022	3.0.0	RULE-1183	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' 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)'	N/A
06/24/2022	3.0.0	RULE-1184	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for UNDER-SUPERVISION-OF-PROV-NPI, then CLAIM-HEADER-RECORD-LT.UNDER-SUPERVISION-OF-PROV-NPI is a valid National Provider Identifier (NPI) number'	N/A
06/24/2022	3.0.0	RULE-1185	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12)	N/A
06/24/2022	3.0.0	RULE-1186	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' 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)'	N/A
06/24/2022	3.0.0	RULE-1250	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-6180	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12)	N/A
06/24/2022	3.0.0	RULE-6235	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12)	N/A
06/24/2022	3.0.0	RULE-6335	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2)	N/A
06/24/2022	3.0.0	RULE-6413	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12)	N/A
06/24/2022	3.0.0	RULE-6438	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: S9(5)V9	N/A
06/24/2022	3.0.0	RULE-6491	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(10)	N/A
06/24/2022	3.0.0	RULE-6553	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12)	N/A
06/24/2022	3.0.0	RULE-7013	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2)	N/A
06/24/2022	3.0.0	RULE-7062	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12)	N/A
06/24/2022	3.0.0	RULE-976	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99	N/A
06/24/2022	3.0.0	RULE-1395	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99	N/A
06/24/2022	3.0.0	RULE-1553	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-1554	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '121', '122', then CLAIM-HEADER-RECORD-OT has a null or invalid value for REFERRING-PROV-TAXONOMY'	N/A
06/24/2022	3.0.0	RULE-1555	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-1556	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-1561	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: S9(5)V9	N/A
06/24/2022	3.0.0	RULE-1585	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be a valid date of the form CCYYMMDD	N/A
06/24/2022	3.0.0	RULE-1594	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for UNDER-DIRECTION-OF-PROV-NPI, then CLAIM-HEADER-RECORD-OT.UNDER-DIRECTION-OF-PROV-NPI is a valid National Provider Identifier (NPI) number'	N/A
06/24/2022	3.0.0	RULE-1595	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-1599	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-1709	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for HCPCS-RATE, then CLAIM-LINE-RECORD-OT.HCPCS-RATE does not contain any pipe (\|) or asterisk (*) characters'	N/A
06/24/2022	3.0.0	RULE-6218	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2)	N/A
06/24/2022	3.0.0	RULE-6336	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(14)	N/A
06/24/2022	3.0.0	RULE-6401	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2)	N/A
06/24/2022	3.0.0	RULE-6632	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12)	N/A
06/24/2022	3.0.0	RULE-6790	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12)	N/A
06/24/2022	3.0.0	RULE-6818	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(10)	N/A
06/24/2022	3.0.0	RULE-6819	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99	N/A
06/24/2022	3.0.0	RULE-6832	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12)	N/A
06/24/2022	3.0.0	RULE-6854	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(10)	N/A
06/24/2022	3.0.0	RULE-1793	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99	N/A
06/24/2022	3.0.0	RULE-1854	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-1855	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-1856	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-1894	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-6171	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(10)	N/A
06/24/2022	3.0.0	RULE-6479	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2)	N/A
06/24/2022	3.0.0	RULE-6542	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12)	N/A
06/24/2022	3.0.0	RULE-6745	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2)	N/A
06/24/2022	3.0.0	RULE-6924	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12)	N/A
03/11/2022	3.0.0	RULE-7400	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', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT'	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', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-HEADER-RECORD-IP.SERVICE-TRACKING-PAYMENT-AMT is not equal to '0’
03/11/2022	3.0.0	RULE-7401	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.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT'	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.ADJUSTMENT-IND does not equal '1'and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-HEADER-RECORD-LT.SERVICE-TRACKING-PAYMENT-AMT is not equal to '0’
03/11/2022	3.0.0	RULE-7402	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-HEADER-RECORD-OT.SERVICE-TRACKING-PAYMENT-AMT is not equal to '0’
03/11/2022	3.0.0	RULE-7403	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-HEADER-RECORD-RX.SERVICE-TRACKING-PAYMENT-AMT is not equal to '0’
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''
03/11/2022	3.0.0	RULE-7523	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT does not equal '0.00''	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', '5’, ’6’ and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT does not equal '0.00''
03/11/2022	3.0.0	RULE-7524	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT does not equal '0.00''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4', '5’, ’6’ and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMTand CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT does not equal '0.00''
03/11/2022	3.0.0	RULE-7521	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', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-IP has a non-null value for SERVICE-TRACKING-TYPE'	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', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-IP has a non-null value for SERVICE-TRACKING-TYPE and CLAIM-HEADER-RECORD-IP.SERVICE-TRACKING-TYPE does not equal '0’and CLAIM-HEADER-RECORD-IP.SERVICE-TRACKING-TYPE does not equal '00’
03/11/2022	3.0.0	RULE-7404	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.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-LT has a non-null value for SERVICE-TRACKING-TYPE'	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.ADJUSTMENT-IND does not equal '1'and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-LT has a non-null value for SERVICE-TRACKING-TYPE and CLAIM-HEADER-RECORD-LT.SERVICE-TRACKING-TYPE does not equal '0’ and CLAIM-HEADER-RECORD-LT.SERVICE-TRACKING-TYPE does not equal '00’
03/11/2022	3.0.0	RULE-7405	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-OT has a non-null value for SERVICE-TRACKING-TYPE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-OT has a non-null value for SERVICE-TRACKING-TYPE and CLAIM-HEADER-RECORD-OT.SERVICE-TRACKING-TYPE does not equal '0’ and CLAIM-HEADER-RECORD-OT.SERVICE-TRACKING-TYPE does not equal '00’
03/11/2022	3.0.0	RULE-7406	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-RX has a non-null value for SERVICE-TRACKING-TYPE'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-RX has a non-null value for SERVICE-TRACKING-TYPE and CLAIM-HEADER-RECORD-RX.SERVICE-TRACKING-TYPE does not equal '0’ and CLAIM-HEADER-RECORD-RX.SERVICE-TRACKING-TYPE does not equal '00’
06/24/2022	3.0.0	Rule-7611	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then if the field is populated, the value must be contained in the set of valid values with id: 'IHS-SERVICE-IND' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
06/24/2022	3.0.0	Rule-7619	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then if the field is populated, the value must be contained in the set of valid values with id: 'IHS-SERVICE-IND' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
06/24/2022	3.0.0	Rule-7631	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then if the field is populated, the value must be contained in the set of valid values with id: 'IHS-SERVICE-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has a non-null value, and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date'
06/24/2022	3.0.0	Rule-7632	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then if the field is populated, the value must be contained in the set of valid values with id: 'PRESCRIPTION-ORIGIN-CODE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has a non-null value, and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date'
02/18/2022	3.0.0	ELG224	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \| \|ELG224\|DISABILITY-TYPE-CODE\|[No longer essential - Both data element and associated requirement(s); preserved for file submission integrity. See Data Dictionary v2.3 for specific definition and coding requirement description(s).]\|Conditional\|	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \| \|ELG224\|DISABILITY-TYPE-CODE\|A code to identify disability status in accordance with requirements of Section 4302 of the Affordable Care Act.\| Mandatory\|
03/11/2022	3.0.0	RULE-709	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP.OUTLIER-CODE is equal to one of the following: '01', '02', '10', then CLAIM-HEADER-RECORD-IP has a valid, non-null value for DRG-OUTLIER-AMT'	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.OUTLIER-CODE is equal to one of the following: '01', '02', '10', then CLAIM-HEADER-RECORD-IP has a valid, non-null value for DRG-OUTLIER-AMT'
04/01/2022	3.0.0	RULE-7637	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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is greater than zero and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
04/01/2022	3.0.0	RULE-7638	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.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 one of the following: '1', '5' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is greater than zero 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 '02', then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
04/01/2022	3.0.0	RULE-7639	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 2', '5' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is greater than zero and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
04/01/2022	3.0.0	RULE-7640	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is greater than zero and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE'
04/01/2022	3.0.0	ELG073	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME\| NECESSITY\|CODING REQUIREMENT\| ELG073\|ELIGIBLE-PHONE-NUM\|Optional\|\|	DE NO\| DATA ELEMENT NAME\| NECESSITY\|CODING REQUIREMENT\| ELG073\|ELIGIBLE-PHONE-NUM\|Conditional\|Value is mandatory and must be provided when the ELIGIBLE-ADDR-TYPE (ELG.004.065) = ‘01’\|
06/24/2022	3.0.0	RULE-2388	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE' and (if MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is non-null then MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE >= Valid Values Effective-Date and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-6584	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(10)	N/A
06/24/2022	3.0.0	RULE-6966	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(1)	N/A
06/24/2022	3.0.0	RULE-2710	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and (if NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE is non-null then NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE >= Valid Values Effective-Date and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-2711	UPDATE	Data Dictionary - Validation Rules	'if NATIONAL-HEALTH-CARE-ENTITY-ID-INFO has a valid, non-null value for SUBMITTING-STATE and FILE-HEADER-RECORD-MANAGED-CARE has a valid, non-null value for SUBMITTING-STATE, then NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.SUBMITTING-STATE refers to the same state as FILE-HEADER-RECORD-MANAGED-CARE.SUBMITTING-STATE'	N/A
06/24/2022	3.0.0	RULE-2713	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: 9(11)	N/A
06/24/2022	3.0.0	RULE-2714	UPDATE	Data Dictionary - Validation Rules	Field RECORD-NUMBER should be unique across all records of type NATIONAL-HEALTH-CARE-ENTITY-ID-INFO	N/A
06/24/2022	3.0.0	RULE-2716	UPDATE	Data Dictionary - Validation Rules	'if NATIONAL-HEALTH-CARE-ENTITY-ID-INFO has a valid, non-null value for STATE-PLAN-ID-NUM, then NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.STATE-PLAN-ID-NUM does not contain any pipe (\|) or asterisk (*) characters'	N/A
06/24/2022	3.0.0	RULE-2720	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE' and (if NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE is non-null then NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE >= Valid Values Effective-Date and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-2722	UPDATE	Data Dictionary - Validation Rules	'if NATIONAL-HEALTH-CARE-ENTITY-ID-INFO has a valid, non-null value for NATIONAL-HEALTH-CARE-ENTITY-NAME, then NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-NAME does not contain any pipe (\|) or asterisk (*) characters'	N/A
06/24/2022	3.0.0	RULE-2723	UPDATE	Data Dictionary - Validation Rules	Value must be a valid date of the form CCYYMMDD	N/A
06/24/2022	3.0.0	RULE-2725	UPDATE	Data Dictionary - Validation Rules	'if NATIONAL-HEALTH-CARE-ENTITY-ID-INFO has a valid, non-null value for NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO has a valid, non-null value for NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-END-DATE, then NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE is less than or equal to NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-END-DATE'	N/A
06/24/2022	3.0.0	RULE-2726	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE	N/A
06/24/2022	3.0.0	RULE-2729	UPDATE	Data Dictionary - Validation Rules	Value must be a valid date of the form CCYYMMDD	N/A
06/24/2022	3.0.0	RULE-2733	UPDATE	Data Dictionary - Validation Rules	'if NATIONAL-HEALTH-CARE-ENTITY-ID-INFO has a valid, non-null value for STATE-NOTATION, then NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.STATE-NOTATION does not contain any pipe (\|) or asterisk (*) characters'	N/A
06/24/2022	3.0.0	RULE-2736	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and (if CHPID-SHPID-RELATIONSHIPS.CHPID-SHPID-RELATIONSHIP-EFF-DATE is non-null then CHPID-SHPID-RELATIONSHIPS.CHPID-SHPID-RELATIONSHIP-EFF-DATE >= Valid Values Effective-Date and CHPID-SHPID-RELATIONSHIPS.CHPID-SHPID-RELATIONSHIP-EFF-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-2738	UPDATE	Data Dictionary - Validation Rules	'if CHPID-SHPID-RELATIONSHIPS has a valid, non-null value for SUBMITTING-STATE and FILE-HEADER-RECORD-MANAGED-CARE has a valid, non-null value for SUBMITTING-STATE, then CHPID-SHPID-RELATIONSHIPS.SUBMITTING-STATE refers to the same state as FILE-HEADER-RECORD-MANAGED-CARE.SUBMITTING-STATE'	N/A
06/24/2022	3.0.0	RULE-2740	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: 9(11)	N/A
06/24/2022	3.0.0	RULE-2741	UPDATE	Data Dictionary - Validation Rules	Field RECORD-NUMBER should be unique across all records of type CHPID-SHPID-RELATIONSHIPS	N/A
06/24/2022	3.0.0	RULE-2743	UPDATE	Data Dictionary - Validation Rules	'if CHPID-SHPID-RELATIONSHIPS has a valid, non-null value for STATE-PLAN-ID-NUM, then CHPID-SHPID-RELATIONSHIPS.STATE-PLAN-ID-NUM does not contain any pipe (\|) or asterisk (*) characters'	N/A
06/24/2022	3.0.0	RULE-2747	UPDATE	Data Dictionary - Validation Rules	Value must be a valid date of the form CCYYMMDD	N/A
06/24/2022	3.0.0	RULE-2749	UPDATE	Data Dictionary - Validation Rules	'if CHPID-SHPID-RELATIONSHIPS has a valid, non-null value for CHPID-SHPID-RELATIONSHIP-EFF-DATE and CHPID-SHPID-RELATIONSHIPS has a valid, non-null value for CHPID-SHPID-RELATIONSHIP-END-DATE, then CHPID-SHPID-RELATIONSHIPS.CHPID-SHPID-RELATIONSHIP-EFF-DATE is less than or equal to CHPID-SHPID-RELATIONSHIPS.CHPID-SHPID-RELATIONSHIP-END-DATE'	N/A
06/24/2022	3.0.0	RULE-2750	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE	N/A
06/24/2022	3.0.0	RULE-2752	UPDATE	Data Dictionary - Validation Rules	Value must be a valid date of the form CCYYMMDD	N/A
06/24/2022	3.0.0	RULE-2756	UPDATE	Data Dictionary - Validation Rules	'if CHPID-SHPID-RELATIONSHIPS has a valid, non-null value for STATE-NOTATION, then CHPID-SHPID-RELATIONSHIPS.STATE-NOTATION does not contain any pipe (\|) or asterisk (*) characters'	N/A
06/24/2022	3.0.0	RULE-6114	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(10)	N/A
06/24/2022	3.0.0	RULE-6135	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(10)	N/A
06/24/2022	3.0.0	RULE-6161	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(12)	N/A
06/24/2022	3.0.0	RULE-6228	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(8)	N/A
06/24/2022	3.0.0	RULE-6240	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(1)	N/A
06/24/2022	3.0.0	RULE-6468	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(500)	N/A
06/24/2022	3.0.0	RULE-6631	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(2)	N/A
06/24/2022	3.0.0	RULE-6635	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(12)	N/A
06/24/2022	3.0.0	RULE-6668	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(500)	N/A
06/24/2022	3.0.0	RULE-6749	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(2)	N/A
06/24/2022	3.0.0	RULE-6838	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(10)	N/A
06/24/2022	3.0.0	RULE-7021	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(50)	N/A
06/24/2022	3.0.0	RULE-7035	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(8)	N/A
06/24/2022	3.0.0	RULE-3185	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE' and (if TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE is non-null then TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE >= Valid Values Effective-Date and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE <= Valid Values End-Date)'	N/A
06/24/2022	3.0.0	RULE-6130	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(1)	N/A
06/24/2022	3.0.0	RULE-6200	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(10)	N/A
06/24/2022	3.0.0	RULE-6437	UPDATE	Data Dictionary - Validation Rules	Value must be compatible with specified T-MSIS picture format: X(50)	N/A
04/01/2022	3.0.0	ELG215	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|END_DATE\|VALUE\|NAME\|DESCRIPTION AMERICAN-INDIAN-ALASKA-NATIVE-INDICATOR\|20200214\|2\|Yes, Individual does have CDIB	VALUE_SET_ID\|END_DATE\|VALUE\|NAME\|DESCRIPTION AMERICAN-INDIAN-ALASKA-NATIVE-INDICATOR\|20171201\|2\|Yes, Individual does have CDIB
06/24/2022	3.0.0	Rule-1934	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(8)V999
06/24/2022	3.0.0	Rule-1935	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(8)V999
06/24/2022	3.0.0	Rule-6935	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4)	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(5)
06/24/2022	3.0.0	CIP195	UPDATE	Data Dictionary	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE SEGMENT (with RECORD-ID) CIP195\|DRG-REL-WEIGHT\|X(8)\|CLAIM-HEADER-RECORD-IP-CIP00002	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE SEGMENT (with RECORD-ID) CIP195\|DRG-REL-WEIGHT\|S9(3)V99999)\|CLAIM-HEADER-RECORD-IP-CIP00002
06/24/2022	3.0.0	CIP195/ DRG-REL-WEIGHT	Modify Data Type	Data Dictionary - Record Layout	DE_NO\|DATA_ELEMENT_NAME\|SIZE\| CIP195\|DRG-REL-WEIGHT\|X(8)\|	DE_NO\|DATA_ELEMENT_NAME\|SIZE\| CIP195\|DRG-REL-WEIGHT\|S9(3)V99999
09/26/2022	3.0.3	N/A	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\| PROV-SPECIALTY\|00010101\|99991231\|C0\|Sleep Medicine\| PROV-SPECIALTY\|00010101\|99991231\|C1\|Centralized Flu\| PROV-SPECIALTY\|00010101\|99991231\|C2\|Indirect Payment Procedure\| PROV-SPECIALTY\|00010101\|99991231\|C3\|Interventional Cardiology\| PROV-SPECIALTY\|00010101\|99991231\|C4\|Restricted Use\| PROV-SPECIALTY\|00010101\|99991231\|C5\|Dentist\| PROV-SPECIALTY\|00010101\|99991231\|C6\|Hospitalist\| PROV-SPECIALTY\|00010101\|99991231\|C7\|Advanced Heart Failure and Transplant Cardiology\| PROV-SPECIALTY\|00010101\|99991231\|C8\|Medical Toxicology\| PROV-SPECIALTY\|00010101\|99991231\|C9\|Hematopoietic Cell Transplantation and Cellular Therapy\| PROV-SPECIALTY\|00010101\|99991231\|D1\|Medicare Diabetes Preventive Program\| PROV-SPECIALTY\|00010101\|99991231\|D2\|Restricted Use\| PROV-SPECIALTY\|00010101\|99991231\|D3\|Medical Genetics and Genomics\| PROV-SPECIALTY\|00010101\|99991231\|D4\|Undersea and Hyperbaric Medicine\| PROV-SPECIALTY\|00010101\|99991231\|D5\|Opioid Treatment Program\| PROV-SPECIALTY\|00010101\|99991231\|D6\|Home Infusion Therapy Services\| PROV-SPECIALTY\|00010101\|99991231\|D7\|Micrographic Dermatologic Surgery\| PROV-SPECIALTY\|00010101\|99991231\|D8\|Adult Congenital Heart Disease\|
04/01/2022	3.0.0	N/A	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILTY-GROUP\|20220401\|20270330\|77\|Medicaid - Women who are pregnant or postpartum, 12-month extended postpartum coverage ELIGIBILTY-GROUP\|20220401\|20270330\|78\|CHIP - Women who are pregnant or postpartum, 12-month extended postpartum coverage
06/24/2022	3.0.0	COT183	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION\|CODING REQUIREMENT COT183\|OT-RX-CLAIM-QUANTITY-ACTUAL\|The quantity of a drug, service, or product that is rendered/dispensed for a prescription, specific date of service, or billing time span.\|For use with CLAIMOT and CLAIMRX claims. For CLAIMIP and CLAIMOT claims/encounter records, use the IP-LT-QUANTITY-OF-SERVICE field. The value in OT-RX-CLAIM-QUANTITY-ACTUAL must correspond with the value in UNIT-OF-MEASURE.This field is only applicable when the service being billed can be quantified in discrete units, e.g., a number of visits or the number of units of a prescription/refill that were filled. For prescriptions/refills, use the Medicaid Drug Rebate definition of a unit, which is the smallest unit by which the drug is normally measured; e.g. tablet, capsule, milliliter, etc. For drugs not identifiable or dispensed by a normal unit, e.g. powder filled vials, use 1 as the number of units	\|DE NO\| DATA ELEMENT NAME\|DEFINITION\|CODING REQUIREMENT COT183\|SERVICE-QUANTITY-ACTUAL\|The quantity of a service or product that is rendered for a specific date of service or billing time span as reported by revenue code or procedure code on the claim line.\| For use with CLAIMOT and CLAIMRX claims. For CLAIMIP and CLAIMOT claims/encounter records, use the SERVICE-QUANTITY-ACTUAL field.The value in SERVICE-QUANTITY-ACTUAL must correspond with the value in UNIT-OF-MEASURE.This field is only applicable when the service being billed can be quantified in discrete units, e.g., a number of visits or the number of units of a prescription/refill that were filled.
06/24/2022	3.0.0	RULE-1653	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(8)V999
06/24/2022	3.0.0	RULE-6183	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(8)V999
06/24/2022	3.0.0	RULE-1926	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(5)V99	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(5)V99
06/24/2022	3.0.0	RULE-1934	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(8)V999
06/24/2022	3.0.0	RULE-1935	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(8)V999
06/24/2022	3.0.0	Rule-7357	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-RX has a non-null value for OT-RX-CLAIM-QUANTITY-ACTUAL'	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR is equal to '0' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-RX has a non-null value for PRESCRIPTION-QUANTITY-ACTUAL'
06/24/2022	3.0.0	RULE-2057	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'PRIMARY-LANGUAGE-ENGL-PROF-CODE' and (if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is non-null then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= Valid Values End-Date)'	'If the field is populated, the value must be contained in the set of valid values with id: 'ENGL-PROF-CODE' and (if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is non-null then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= Valid Values End-Date)'
06/24/2022	3.0.0	RULE-2434	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR' and (if RACE-INFORMATION.RACE-DECLARATION-EFF-DATE is non-null then RACE-INFORMATION.RACE-DECLARATION-EFF-DATE >= Valid Values Effective-Date and RACE-INFORMATION.RACE-DECLARATION-EFF-DATE <= Valid Values End-Date)'	'If the field is populated, the value must be contained in the set of valid values with id: 'AMERICAN-INDIAN-ALASKA-NATIVE-INDICATOR' and (if RACE-INFORMATION.RACE-DECLARATION-EFF-DATE is non-null then RACE-INFORMATION.RACE-DECLARATION-EFF-DATE >= Valid Values Effective-Date and RACE-INFORMATION.RACE-DECLARATION-EFF-DATE <= Valid Values End-Date)'
04/22/2022	3.0.0	Rule-7569	UPDATE	Data Dictionary - Validation Rules	if PROV-ATTRIBUTES-MAIN has a non-null value for SUBMITTING-STATE-PROV-ID and PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03', then there is no more than one PROV-IDENTIFIERS segment with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2'	if PROV-ATTRIBUTES-MAIN has a non-null value for SUBMITTING-STATE-PROV-ID and PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03', then there is no more than one distinct PROV-IDENTIFIER in PROV-IDENTIFIERS segment with matching join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2'
06/24/2022	3.0.0	RULE-6774	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(8)	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: S9(3)V99999)
07/15/2022	3.0.1	N/A	ADD	Data Dictionary - Valid Values	N/A	add new valid value file DATA-DICTIONARY-VERSION.psv
05/13/2022	3.0.0	N/A	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION XIX-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|10\|Clinic Services\|10. Clinic Services (See 42 CFR 440.90.).--These are preventive, diagnostic, therapeutic, rehabilitative, or palliative items or services that: Are provided to outpatients; • Are provided by a facility that is not part of a hospital but is organized and operated to provide medical care to outpatients. For reporting purposes, consider a group of physicians who share, only for mutual convenience, space, services of supporting staff, etc., as physicians, rather than a clinic, even though they practice under the name of a clinic; and • Except in the case of nurse-midwife services (see 42 CFR 440.165), are furnished by, or under, the direction of a physician. NOTE: Place dental clinics under Dental Services. Report any services not included above under Other Care Services. A clinic staff may include practitioners with different specialties.\| XIX-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|49\|Other Care Services\|49 -- Other Care Services --These are any medical or remedial care services recognized under State law and authorized by the approved Medicaid State Plan. Such services do not meet the definition of, and are not classified under, any category of service included on Lines 1 through 41. \| XIX-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|50\|Total\|Total\|	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION XIX-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|20210930\|10\| XIX-MBESCBES-CATEGORY-OF-SERVICE\|20211001\|99991231\|10A\|Clinic Services - Reg. Payments\|10A. Clinic Services - Reg. Payments (See 42 CFR 440.90.).--These are preventive, diagnostic, therapeutic, rehabilitative, or palliative items or services that: o Are provided to outpatients; o Are provided by a facility that is not part of a hospital but is organized and operated to provide medical care to outpatients. For reporting purposes, consider a group of physicians who share, only for mutual convenience, space, services of supporting staff, etc., as physicians, rather than a clinic, even though they practice under the name of a clinic; and o Except in the case of nurse-midwife services (see 42 CFR 440.165), are furnished by, or under, the direction of a physician. NOTE: Place dental clinics under Dental Services. Report any services not included above under Other Care Services. A clinic staff may include practitioners with different specialties.\| XIX-MBESCBES-CATEGORY-OF-SERVICE\|20211001\|99991231\|10B\|Clinic Services - Sup. Payments\|10B. Clinic Services - Sup. Payments (See 42 CFR 440.90.).--These are preventive, diagnostic, therapeutic, rehabilitative, or palliative items or services that: o Are provided to outpatients; o Are provided by a facility that is not part of a hospital but is organized and operated to provide medical care to outpatients. For reporting purposes, consider a group of physicians who share, only for mutual convenience, space, services of supporting staff, etc., as physicians, rather than a clinic, even though they practice under the name of a clinic; and o Except in the case of nurse-midwife services (see 42 CFR 440.165), are furnished by, or under, the direction of a physician. NOTE: Place dental clinics under Dental Services. Report any services not included above under Other Care Services. A clinic staff may include practitioners with different specialties.\| XIX-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|20211231\|49\| XIX-MBESCBES-CATEGORY-OF-SERVICE\|20220101\|99991231\|69\|Other Care Services\|69 - Other Care Services --These are any medical or remedial care services recognized under State law and authorized by the approved Medicaid State Plan. Such services do not meet the definition of, and are not classified under, any category of service included on Lines 1 through 41.\| XIX-MBESCBES-CATEGORY-OF-SERVICE\|20220101\|99991231\|70\|Total\|Line 70 - TOTAL.--The MBES automatically enters the total of Columns (a)- (e).\| XIX-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|20211231\|50\|
06/24/2022	3.0.0	CRX162	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX162\|PRESCRIPTION-ORIGIN-CODE\|Conditional\|How the prescription was sent to the pharmacy.\|Value must be one digit Value must be 1:4\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002
06/24/2022	3.0.0	CRX162	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|DESCRIPTION\| PRESCRIPTION-ORIGIN-CODE\|20220624\|99991231\|1\|Written PRESCRIPTION-ORIGIN-CODE\|20220624\|99991231\|2\|Telephone PRESCRIPTION-ORIGIN-CODE\|20220624\|99991231\|3\|Electronic PRESCRIPTION-ORIGIN-CODE\|20220624\|99991231\|4\|Fax
05/13/2022	3.0.0	N/A	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION XIX-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|29\|Non-Emergency Medical Transportation XIX-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|37\|Critical Access Hospitals	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION XIX-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|20211231\|29\|Non-Emergency Medical Transportation XIX-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|20211231\|37\|Critical Access Hospitals XIX-MBESCBES-CATEGORY-OF-SERVICE\|20220101\|99991231\|29A\|Non-Emergency Medical Transportation - Reg. Payments\|29A. -Non-Emergency Medical Transportation - Reg. Payments\| XIX-MBESCBES-CATEGORY-OF-SERVICE\|20220101\|99991231\|29B\|Non-Emergency Medical Transportation - Sup. Payments\| XIX-MBESCBES-CATEGORY-OF-SERVICE\|20220101\|99991231\|37A\|Critical Access Hospitals - Reg. Payments\|37A. -Critical Access Hospitals - Reg. Payments\| XIX-MBESCBES-CATEGORY-OF-SERVICE\|20220101\|9991231\|37B\|Critical Access Hospitals - Sup. Payments\|37B. -Critical Access Hospitals Inpatient - Sup. Payments\| XIX-MBESCBES-CATEGORY-OF-SERVICE\|20220101\|9991231\|37C\|Critical Access Hospitals Outpatient - Sup. Payments\|37C. -Critical Access Hospitals Outpatient - Sup. Payments\|
05/13/2022	3.0.0	RULE-7642	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 is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys
05/13/2022	3.0.0	RULE-7643	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 is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to one of the following: '1' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys
05/13/2022	3.0.0	RULE-7644	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to one of the following: '1'and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686',then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys
05/13/2022	3.0.0	RULE-7645	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys
05/13/2022	3.0.0	RULE-7646	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to one of the following: '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686', then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys
04/22/2022	3.0.0	N/A	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILTY-GROUP\|20220401\|20270330\|77\|Medicaid - Women who are pregnant or postpartum, 12-month extended postpartum coverage ELIGIBILTY-GROUP\|20220401\|20270330\|78\|CHIP - Women who are pregnant or postpartum, 12-month extended postpartum coverage	N/A
06/03/2022	3.0.0	RULE-7647	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' then CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND must have a non-null value
06/03/2022	3.0.0	RULE-7648	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' then CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND must have a non-null value
06/03/2022	3.0.0	RULE-7649	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' then CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND must have a non-null value
06/03/2022	3.0.0	RULE-7650	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' then CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND must have a non-null value
06/03/2022	3.0.0	Rule-7652	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' then CLAIM-LINE-RECORD-IP.LINE-ADJUSTMENT-IND must have a non-null value
06/03/2022	3.0.0	Rule-7653	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' then CLAIM-LINE-RECORD-LT.LINE-ADJUSTMENT-IND must have a non-null value
06/03/2022	3.0.0	Rule-7654	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' then CLAIM-LINE-RECORD-OT.LINE-ADJUSTMENT-IND must have a non-null value
06/03/2022	3.0.0	Rule-7655	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' then CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-IND must have a non-null value
06/03/2022	3.0.0	RULE-7651	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B' then CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND must have a non-null value'
06/03/2022	3.0.0	RULE-7656	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B' then CLAIM-LINE-RECORD-OT.LINE-ADJUSTMENT-IND must have a non-null value'
05/13/2022	3.0.0	RULE-7633	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 is not equal to 'Z' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' then CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'	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 is not equal to 'Z' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type CLAIM-LINE-RECORD-IP that matches on join keys and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'
05/13/2022	3.0.0	RULE-7634	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 is not equal to 'Z' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' then CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'	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 is not equal to 'Z' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type CLAIM-LINE-RECORD-LT that matches on join keys and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'
05/13/2022	3.0.0	RULE-7635	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to 'Z' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654', and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654', then CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to 'Z' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654', and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654', then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type CLAIM-LINE-RECORD-OT that matches on join keys and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'
05/13/2022	3.0.0	RULE-7636	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to 'Z' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: ''026', '087’,26', '87', '542', '585', '654' then CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to 'Z' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: ''026', '087’,26', '87', '542', '585', '654' then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type CLAIM-LINE-RECORD-RX that matches on join keys and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'
07/15/2022	3.0.1	N/A	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|\|DESCRIPTION BED-TYPE-CODE\|00010101\|99991231\|1\|Intermediate Care Facility for the Intellectually Disabled\| BED-TYPE-CODE\|00010101\|99991231\|2\|Inpatient\| BED-TYPE-CODE\|00010101\|99991231\|3\|Nursing Facility\| BED-TYPE-CODE\|00010101\|99991231\|4\|Title 18 Skilled Nursing Facility (T18 SNF)\|	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|\|DESCRIPTION BED-TYPE-CODE\|00010101\|99991231\|1\|Intermediate Care Facility for the Intellectually Disabled bed not in an Institution for Mental Disease\| BED-TYPE-CODE\|00010101\|99991231\|2\|Inpatient bed not in an Institution for Mental Disease\| BED-TYPE-CODE\|00010101\|99991231\|3\|Nursing Facility bed not in an Institution for Mental Disease\| BED-TYPE-CODE\|00010101\|99991231\|4\|Title 18 Skilled Nursing Facility (T18 SNF) bed not in an Institution for Mental Disease\|
07/15/2022	3.0.1	N/A	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|\|DESCRIPTION BED-TYPE-CODE\|00010101\|99991231\|5\|Intermediate Care Facility for the Intellectually Disabled bed in an Institution for Mental Disease\| BED-TYPE-CODE\|00010101\|99991231\|6\|Inpatient bed in an Institution for Mental Disease\| BED-TYPE-CODE\|00010101\|99991231\|7\|Nursing Facility bed in an Institution for Mental Disease\|
06/24/2022	3.0.0	ELG095	UPDATE	Data Dictionary	DE No\|Segment Name\|DE Name\|Definition ELG095\|ELIGIBILITY-DETERMINANTS-ELG00005\|ELIGIBILITY-CHANGE-REASON\|The reason for a change in an individual's eligibility status. Report this reason when there is a change in the individual's eligibility status.	DE No\|Segment Name\|DE Name\|Definition ELG095\|ELIGIBILITY-DETERMINANTS-ELG00005\|ELIGIBILITY-CHANGE-REASON\|The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed.
08/05/2022	3.0.1	Rule-7641	UPDATE	Data Dictionary - Validation Rules	if VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM and VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-BENEFICIARY-IDENTIFIER or VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-HIC-NUM' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE, then ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10'	if ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: "01", "02", "03", "04", "05", "06", "08", "09", "10"and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to 'cutover date' and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals "1",then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (MAX(ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, 'cutover date') >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE),and (VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-HIC-NUM or VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-BENEFICIARY-IDENTIFIER)
08/05/2022	3.0.1	Rule-7677	ADD	Data Dictionary - Validation Rules	N/A	if (VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-BENEFICIARY-IDENTIFIER or VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-HIC-NUM')and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to ‘cutover date', and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1'then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10'and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE, 'cutover date’) is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)
07/15/2022	3.0.1	CIP252	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP252\|ALLOWED-AMT\|The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP252\|ALLOWED-AMT\|The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity allowed at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	CLT205	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT205\|ALLOWED-AMT\|The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT205\|ALLOWED-AMT\|The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity allowed at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	COT175	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT175\|ALLOWED-AMT\|The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT175\|ALLOWED-AMT\|The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity allowed at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	CRX122	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX122\|ALLOWED-AMT\|The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX122\|ALLOWED-AMT\|The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity allowed at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	COT033	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT033\|BEGINNING-DATE-OF-SERVICE\|For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, this would be the date on which the service covered by this claim began. For capitation premium payments, the date on which the period of coverage related to this payment began. For financial transactions reported to the OT file, populate with the first day of the time period covered by this financial transaction.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT033\|BEGINNING-DATE-OF-SERVICE\|For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, this would be the date on which the service covered by this claim began. For capitation premium payments, the date on which the period of coverage related to this payment began. For financial transactions reported to the OT file, populate with the first day of the time period covered by this financial transaction. For sub-capitation payments, this represents the first date of the period the sub-capitation payment covers.
07/15/2022	3.0.1	COT166	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT166\|BEGINNING-DATE-OF-SERVICE\|For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, this would be the date on which the service covered by this claim began. For capitation premium payments, the date on which the period of coverage related to this payment began. For financial transactions reported to the OT file, populate with the first day of the time period covered by this financial transaction.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT166\|BEGINNING-DATE-OF-SERVICE\|For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, this would be the date on which the service covered by this claim began. For capitation premium payments, the date on which the period of coverage related to this payment began. For financial transactions reported to the OT file, populate with the first day of the time period covered by this financial transaction. For sub-capitation payments, this represents the first date of the period the sub-capitation payment covers.
07/15/2022	3.0.1	COT174	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT174\|BILLED-AMT\|The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT174\|BILLED-AMT\|The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	CRX121	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX121\|BILLED-AMT\|The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX121\|BILLED-AMT\|The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	COT113	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT113\|BILLING-PROV-NPI-NUM\|The National Provider ID (NPI) of the billing entity responsible for billing a patient for healthcare services. The billing provider can also be servicing, referring, or prescribing provider. Can be admitting provider except for Long Term Care.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT113\|BILLING-PROV-NPI-NUM\|The National Provider ID (NPI) of the billing entity responsible for billing a patient for healthcare services. The billing provider can also be servicing, referring, or prescribing provider. Can be admitting provider except for Long Term Care. For sub-capitation payments, report the national provider identifier (NPI) for the sub-capitated entity if the provider has one.
07/15/2022	3.0.1	COT112	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT112\|BILLING-PROV-NUM\|A unique identification number assigned by the state to a provider or capitation plan. This data element should represent the entity billing for the service. For encounter records, if associated Type of Claim value equals 3, C, or W, then value must be the state identifier of the provider or entity (billing or reporting) to the managed care plan.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT112\|BILLING-PROV-NUM\|A unique identification number assigned by the state to a provider or capitation plan. This data element should represent the entity billing for the service. For encounter records, if associated Type of Claim value equals 3, C, or W, then value must be the state identifier of the provider or entity (billing or reporting) to the managed care plan. For sub-capitation payments, report the state-assigned provider identifier for the sub-capitated entity, when available or required.
07/15/2022	3.0.1	COT034	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT034\|ENDING-DATE-OF-SERVICE\|For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, the date on which the service covered by this claim ended. For capitation premium payments, the date on which the period of coverage related to this payment ends/ended. For financial transactions reported to the OT file, populate with the last day of the time period covered by this financial transaction.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT034\|ENDING-DATE-OF-SERVICE\|For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, the date on which the service covered by this claim ended. For capitation premium payments, the date on which the period of coverage related to this payment ends/ended. For financial transactions reported to the OT file, populate with the last day of the time period covered by this financial transaction. For sub-capitation payments, this represents the last date of the period the sub-capitation payment covers.
07/15/2022	3.0.1	COT167	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT167\|ENDING-DATE-OF-SERVICE\|For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, the date on which the service covered by this claim ended. For capitation premium payments, the date on which the period of coverage related to this payment ends/ended. For financial transactions reported to the OT file, populate with the last day of the time period covered by this financial transaction.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT167\|ENDING-DATE-OF-SERVICE\|For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, the date on which the service covered by this claim ended. For capitation premium payments, the date on which the period of coverage related to this payment ends/ended. For financial transactions reported to the OT file, populate with the last day of the time period covered by this financial transaction. For sub-capitation payments, this represents the last date of the period the sub-capitation payment covers.
07/15/2022	3.0.1	CIP254	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP254\|MEDICAID-PAID-AMT\|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP254\|MEDICAID-PAID-AMT\|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	CLT208	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT208\|MEDICAID-PAID-AMT\|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT208\|MEDICAID-PAID-AMT\|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	COT178	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT178\|MEDICAID-PAID-AMT\|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT178\|MEDICAID-PAID-AMT\|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	CRX125	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX125\|MEDICAID-PAID-AMT\|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX125\|MEDICAID-PAID-AMT\|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	COT066	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT066\|PLAN-ID-NUMBER\|A unique number assigned by the state which represents a distinct comprehensive managed care plan, prepaid health plan, primary care case management program, a program for all-inclusive care for the elderly entity, or other approved plans.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT066\|PLAN-ID-NUMBER\|A unique number assigned by the state which represents a distinct comprehensive managed care plan, prepaid health plan, primary care case management program, a program for all-inclusive care for the elderly entity, or other approved plans. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report the PLAN-ID-NUMBER for the MCP (MCO, PIHP, or PAHP that has a contract with a state) that is making the payment to the sub-capitated entity or sub-capitated network provider. For sub-capitation payments, report the PLAN-ID-NUMBER for the managed care plan making the payment to the sub-capitated entity.
07/15/2022	3.0.1	CIP251	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP251\|REVENUE-CHARGE\|The total amount billed for the related Revenue Code. Total amount billed includes both covered and non-covered charges (as defined by UB-04 Billing Manual). For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed to the managed care plan.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP251\|REVENUE-CHARGE\|The total amount billed for the related Revenue Code. Total amount billed includes both covered and non-covered charges (as defined by UB-04 Billing Manual). For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed to the managed care plan. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	CLT204	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT204\|REVENUE-CHARGE\|The total amount billed for the related Revenue Code. Total amount billed includes both covered and non-covered charges (as defined by UB-04 Billing Manual). For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed to the managed care plan.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT204\|REVENUE-CHARGE\|The total amount billed for the related Revenue Code. Total amount billed includes both covered and non-covered charges (as defined by UB-04 Billing Manual). For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed to the managed care plan. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	CIP104	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP104\|SOURCE-LOCATION\|The field denotes the claims payment system from which the claim was extracted.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP104\|SOURCE-LOCATION\|The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.
07/15/2022	3.0.1	CLT056	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT056\|SOURCE-LOCATION\|The field denotes the claims payment system from which the claim was extracted.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT056\|SOURCE-LOCATION\|The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.
07/15/2022	3.0.1	COT041	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT041\|SOURCE-LOCATION\|The field denotes the claims payment system from which the claim was extracted.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT041\|SOURCE-LOCATION\|The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitation payments, report a SOURCE-LOCATION of '20', indicating the managed care plan is the source of payment.
07/15/2022	3.0.1	CRX032	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX032\|SOURCE-LOCATION\|The field denotes the claims payment system from which the claim was extracted.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX032\|SOURCE-LOCATION\|The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.
07/15/2022	3.0.1	CIP113	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP113\|TOT-ALLOWED-AMT\|The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP113\|TOT-ALLOWED-AMT\|The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity allowed for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	CLT064	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT064\|TOT-ALLOWED-AMT\|The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT064\|TOT-ALLOWED-AMT\|The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity allowed for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	COT049	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT049\|TOT-ALLOWED-AMT\|The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT049\|TOT-ALLOWED-AMT\|The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity allowed for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	CRX040	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX040\|TOT-ALLOWED-AMT\|The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX040\|TOT-ALLOWED-AMT\|The claim header level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state's MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity allowed for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	CIP112	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP112\|TOT-BILLED-AMT\|The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP112\|TOT-BILLED-AMT\|The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	CLT063	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT063\|TOT-BILLED-AMT\|The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT063\|TOT-BILLED-AMT\|The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	COT048	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT048\|TOT-BILLED-AMT\|The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT048\|TOT-BILLED-AMT\|The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	CRX039	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX039\|TOT-BILLED-AMT\|The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX039\|TOT-BILLED-AMT\|The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	CIP114	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP114\|TOT-MEDICAID-PAID-AMT\|The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP114\|TOT-MEDICAID-PAID-AMT\|The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	CLT065	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT065\|TOT-MEDICAID-PAID-AMT\|The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT065\|TOT-MEDICAID-PAID-AMT\|The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	COT050	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT050\|TOT-MEDICAID-PAID-AMT\|The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT050\|TOT-MEDICAID-PAID-AMT\|The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field. For sub-capitation payments, this represents the amount paid by the managed care plan to the sub-capitated entity.
07/15/2022	3.0.1	CRX041	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX041\|TOT-MEDICAID-PAID-AMT\|The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX041\|TOT-MEDICAID-PAID-AMT\|The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
07/15/2022	3.0.1	CIP100	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP100\|TYPE-OF-CLAIM\|A code to indicate what type of payment is covered in this claim.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP100\|TYPE-OF-CLAIM\|A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.
07/15/2022	3.0.1	CLT052	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT052\|TYPE-OF-CLAIM\|A code to indicate what type of payment is covered in this claim.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT052\|TYPE-OF-CLAIM\|A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.
07/15/2022	3.0.1	COT037	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT037\|TYPE-OF-CLAIM\|A code to indicate what type of payment is covered in this claim.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT037\|TYPE-OF-CLAIM\|A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record. For sub-capitation payments, report TYPE-OF-CLAIM = '6' or “F”.
07/15/2022	3.0.1	CRX029	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX029\|TYPE-OF-CLAIM\|A code to indicate what type of payment is covered in this claim.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX029\|TYPE-OF-CLAIM\|A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.
07/15/2022	3.0.1	COT186	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT186\|TYPE-OF-SERVICE\|A code to categorize the services provided to a Medicaid or CHIP enrollee.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION COT186\|TYPE-OF-SERVICE\|A code to categorize the services provided to a Medicaid or CHIP enrollee. For sub-capitation payments, report a TYPE-OF-SERVICE value 119, 120, or 122.
06/24/2022	3.0.0	N/A	ADD	Data Dictionary - Valid Values	add values to TYPE-OF-CLAIM.psv	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|\|DESCRIPTION TYPE-OF-CLAIM\|00010101\|99991231\|6\|Medicaid or Medicaid-expansion CHIP financial transaction between an MCP and an entity other than the S-CHIP or Medicaid agency TYPE-OF-CLAIM\|00010101\|99991231\|F\|Separate CHIP (Title XXI) financial transaction between an MCP and an entity other than the S-CHIP or Medicaid agency
06/24/2022	3.0.0	N/A	ADD	Data Dictionary - Valid Values	add values to SOURCE-LOCATION.psv	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|\|DESCRIPTION SOURCE-LOCATION\|00010101\|99991231\|99991231\|22\|Sub-contracted entity SOURCE-LOCATION\|00010101\|99991231\|99991231\|23\|Sub-capitated network provider
06/24/2022	3.0.0	N/A	ADD	Data Dictionary - Valid Values	add values to AFFILIATED-PROGRAM-TYPE.psv	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|\|DESCRIPTION AFFILIATED-PROGRAM-TYPE\|00010101\|99991231\|6\|\|Sub-capitated Network provider – The value in the AFFILIATED-PROGRAM-ID data element contains the state-assigned health plan identifier with which the network provider has a sub-capitated contract to provide services for managed care plan enrollees.
06/24/2022	3.0.0	Rule-7657	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 '0' or '4' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' then (CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00')
06/24/2022	3.0.0	Rule-7658	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' then (CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00')
06/24/2022	3.0.0	Rule-7659	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then (CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00')
06/24/2022	3.0.0	Rule-7660	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' then (CLAIM-LINE-RECORD-RX has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00')
06/24/2022	3.0.0	Rule-7661	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then (CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00')
06/24/2022	3.0.0	Rule-7662	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 '0' or '4'and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '0'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C'then (CLAIM-HEADER-RECORD-IP has a null value for MEDICARE-PAID-AMTor CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT is equal to 0.00)and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-COINS-AMTor CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT is equal to 0.00)and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-DEDUCTIBLE-AMTor CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT is equal to 0.00)
06/24/2022	3.0.0	Rule-7663	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'and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4'and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0'and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C'then (CLAIM-HEADER-RECORD-LT has a null value for MEDICARE-PAID-AMTor CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT is equal to 0.00)and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-COINS-AMTor CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is equal to 0.00)and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMTor CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT is equal to 0.00)
06/24/2022	3.0.0	Rule-7664	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then (CLAIM-LINE-RECORD-OT has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT equals '0.00')and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'
06/24/2022	3.0.0	Rule-7665	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4'and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C',then (CLAIM-LINE-RECORD-RX has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT equals '0.00')and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'
06/24/2022	3.0.0	Rule-7666	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then (CLAIM-LINE-RECORD-OT has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT equals '0.00')and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'
06/24/2022	3.0.0	Rule-7667	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'
06/24/2022	3.0.0	Rule-7668	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then if the 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)'
06/24/2022	3.0.0	Rule-7669	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
06/24/2022	3.0.0	Rule-7670	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
06/24/2022	3.0.0	Rule-7671	ADD	Data Dictionary - Validation Rules	N/A	'If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' 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)'
06/24/2022	3.0.0	Rule-7672	ADD	Data Dictionary - Validation Rules	N/A	'If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
06/24/2022	3.0.0	Rule-7673	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
06/24/2022	3.0.0	Rule-7674	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then if the LINE-ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
06/24/2022	3.0.0	Rule-7675	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
06/24/2022	3.0.0	Rule-7676	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
06/24/2022	3.0.0	RULE-1916	UPDATE	Data Dictionary - Validation Rules	If the LINE-ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date	If the LINE-ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
08/05/2022	3.0.1	RULE-1259	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (((if CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE is non-null then (CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE <= Valid Values End-Date)) OR (if CLAIM-HEADER-RECORD-LT.MEDICAID-PAID-DATE is non-null then (CLAIM-HEADER-RECORD-LT.MEDICAID-PAID-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.MEDICAID-PAID-DATE <= Valid Values End-Date)))'
08/05/2022	3.0.1	RULE-1693	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (((if CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE is non-null then (CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE <= Valid Values End-Date)) OR (if CLAIM-HEADER-RECORD-OT.MEDICAID-PAID-DATE is non-null then (CLAIM-HEADER-RECORD-OT.MEDICAID-PAID-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.MEDICAID-PAID-DATE <= Valid Values End-Date)))'
08/05/2022	3.0.1	RULE-1957	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (((if CLAIM-LINE-RECORD-RX.ADJUDICATION-DATE is non-null then (CLAIM-LINE-RECORD-RX.ADJUDICATION-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.ADJUDICATION-DATE <= Valid Values End-Date)) OR (if CLAIM-HEADER-RECORD-RX.MEDICAID-PAID-DATE is non-null then (CLAIM-HEADER-RECORD-RX.MEDICAID-PAID-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.MEDICAID-PAID-DATE <= Valid Values End-Date)))
08/05/2022	3.0.1	RULE-826	UPDATE	Data Dictionary - Validation Rules	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 field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-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)'	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 field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (((if CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE is non-null then (CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE <= Valid Values End-Date)) OR (if CLAIM-HEADER-RECORD-IP.MEDICAID-PAID-DATE is non-null then (CLAIM-HEADER-RECORD-IP.MEDICAID-PAID-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.MEDICAID-PAID-DATE <= Valid Values End-Date)))
08/05/2022	3.0.1	CIP202	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\|CODING REQUIREMENT CIP202\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount.\|"First five (5) characters of the value must be a Julian date express in the form YYDDD (e.g. 19095, 95th day of 20(19))"	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\|CODING REQUIREMENT CIP202\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The RA is the detailed explanation of the reason for the payment amount.\|\|
08/05/2022	3.0.1	CLT144	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\|CODING REQUIREMENT CLT144\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detaile dexplanation of the reason for the payment amount.\|"First five (5) characters of the value must be a Julian date express in the form YYDDD (e.g. 19095, 95th day of 20(19))"	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\|CODING REQUIREMENT CLT144\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The RA is the detailed explanation of the reason for the payment amount.\|\|
08/05/2022	3.0.1	COT126	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\|CODING REQUIREMENT COT126\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount.\|"First five (5) characters of the value must be a Julian date express in the form YYDDD (e.g. 19095, 95th day of 20(19))"	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\|CODING REQUIREMENT COT126\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The RA is the detailed explanation of the reason for the payment amount.\|\|
08/05/2022	3.0.1	CRX081	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\|CODING REQUIREMENT CRX081\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The first five (5) positions are Julian date following a YYDDD format. The RA is the detailed explanation of the reason for the payment amount.\|"First five (5) characters of the value must be a Julian date express in the form YYDDD (e.g. 19095, 95th day of 20(19))"	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\|CODING REQUIREMENT CRX081\|REMITTANCE-NUM\|The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The RA is the detailed explanation of the reason for the payment amount.\|\|
07/15/2022	3.0.1	N/A	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|\|DESCRIPTION PAYMENT-LEVEL-IND\|00010101\|99991231\|1\|Claim Header - Sum of Line Item payments PAYMENT-LEVEL-IND\|00010101\|99991231\|2\|Claim Detail - Individual Line Item payments	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|\|DESCRIPTION PAYMENT-LEVEL-IND\|00010101\|99991231\|1\|Payment/allowed amount is not determined at the individual line level (e.g., DRG or outpatient PPS) PAYMENT-LEVEL-IND\|00010101\|99991231\|2\|Payment/allowed amount is determined at the individual line level (e.g., RBRVS) and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amount(s)
07/15/2022	3.0.1	N/A	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|\|DESCRIPTION PAYMENT-LEVEL-IND\|00010101\|99991231\|3\|Payment/allowed amount is determined for each individual line (e.g., RBRVS) but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only
07/15/2022	3.0.1	RULE-7678	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-BILLED-AMT'
07/15/2022	3.0.1	RULE-7679	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.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-BILLED-AMT'
07/15/2022	3.0.1	RULE-7680	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-BILLED-AMT'
07/15/2022	3.0.1	RULE-7681	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-BILLED-AMT'
07/15/2022	3.0.1	RULE-7682	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.TYPE-OF-CLAIM is equal to one of the following: 'C', '3' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-IP.PAYMENT-LEVEL-IND equals '2', then CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-IP.MEDICAID-PAID-AMT values, where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
07/15/2022	3.0.1	RULE-7683	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'C', '3' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-LT.PAYMENT-LEVEL-IND equals '2', then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT values, where CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
07/15/2022	3.0.1	RULE-7684	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'C', '3' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-OT.PAYMENT-LEVEL-IND equals '2', then CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT values, where CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
07/15/2022	3.0.1	RULE-7685	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'C', '3' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-RX.PAYMENT-LEVEL-IND equals '2', then CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-RX.MEDICAID-PAID-AMT values, where CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654''
07/15/2022	3.0.1	Rule-7686	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.TYPE-OF-CLAIM is equal to one of the following: 'C', '3' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-IP has a non-null value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-IP.TOT-ALLOWED-AMT does not equal '0.00' and CLAIM-HEADER-RECORD-IP has a non-null value for TOT-ALLOWED-AMT, then CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-IP.TOT-ALLOWED-AMT'
07/15/2022	3.0.1	Rule-7687	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'C', '3' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-LT has a non-null value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT does not equal '0.00' and CLAIM-HEADER-RECORD-LT has a non-null value for TOT-ALLOWED-AMT, then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT'
07/15/2022	3.0.1	Rule-7688	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'C', '3' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-OT has a non-null value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-ALLOWED-AMT does not equal '0.00' and CLAIM-HEADER-RECORD-OT has a non-null value for TOT-ALLOWED-AMT, then CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-OT.TOT-ALLOWED-AMT'
08/26/2022	3.0.2	ELG252	ADD	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT\| ELG252\|ENROLLMENT-TYPE\|	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT\| ELG252\|ENROLLMENT-TYPE\|A person enrolled in Medicaid/CHIP must have a primary eligibility group classification for any given day of enrollment. (There may or may not be a secondary eligibility group classification for that same day.)
08/05/2022	3.0.1	CIP194	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT CIP194\|DRG-OUTLIER-AMT\|Value must not be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT CIP194\|DRG-OUTLIER-AMT\|Value must be populated when Outlier Code (CIP.002.197) is '01' ,'02' or '10'
08/26/2022	3.0.2	CIP132	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| CIP132\|PAYMENT-LEVEL-IND\|The field denotes whether the payment amount was determined at the claim header or line/detail level.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| CIP132\|PAYMENT-LEVEL-IND\|The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
08/26/2022	3.0.2	CLT082	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| CLT082\|PAYMENT-LEVEL-IND\|The field denotes whether the payment amount was determined at the claim header or line/detail level.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| CLT082\|PAYMENT-LEVEL-IND\|The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
08/26/2022	3.0.2	COT068	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| COT068\|PAYMENT-LEVEL-IND\|The field denotes whether the payment amount was determined at the claim header or line/detail level.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| COT068\|PAYMENT-LEVEL-IND\|The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
08/26/2022	3.0.2	CRX058	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| CRX058\|PAYMENT-LEVEL-IND\|The field denotes whether the payment amount was determined at the claim header or line/detail level.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| CRX058\|PAYMENT-LEVEL-IND\|The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header. For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed. For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts.
08/05/2022	3.0.1	RULE-7201	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to o ne of the following: 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)
08/05/2022	3.0.1	RULE-7200	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)
08/05/2022	3.0.1	RULE-7199	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 is not equal to one of the following: 'Z' 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 one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)
08/05/2022	3.0.1	RULE-7198	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 is not equal to one of the following: '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.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)	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.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)
08/05/2022	3.0.1	RULE-7197	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)
08/05/2022	3.0.1	RULE-7196	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to one of the following: '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)
08/05/2022	3.0.1	RULE-7195	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 is not equal to one of the following: 'Z' 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 one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W'and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)
08/05/2022	3.0.1	RULE-7194	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 is not equal to one of the following: '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.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)	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.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)
08/05/2022	3.0.1	Rule-7701	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', 'V' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)
08/05/2022	3.0.1	Rule-7702	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', 'V' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)
08/05/2022	3.0.1	Rule-7703	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', 'V' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)
08/05/2022	3.0.1	Rule-7704	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.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', 'V' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)
08/05/2022	3.0.1	Rule-7705	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '2, 'B', 'V' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)
08/05/2022	3.0.1	Rule-7706	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2, 'B', 'V' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)
08/05/2022	3.0.1	Rule-7707	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '2, 'B', 'V' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)
08/05/2022	3.0.1	Rule-7708	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.TYPE-OF-CLAIM is equal to one of the following: '2, 'B', 'V' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE)
08/05/2022	3.0.1	RULE-7709	ADD	Data Dictionary - Validation Rules	N/A	if MANAGED-CARE-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM, and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is greater than or equal to 'cutover date', then for every record of type MANAGED-CARE-PARTICIPATION, there must be a valid record of type ENROLLMENT-TIME-SPAN that matches on the join keys and (MAX(MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, 'cutover date') >= ENROLLMENT-TIME-SPAN.ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE <= ENROLLMENT-TIME-SPAN.ENROLLMENT-END-DATE)
08/26/2022	3.0.2	Rule-1630	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE, then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal ‘0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal ‘1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: ‘26', ‘026', ‘87', ‘087', ‘542', ‘585', ‘654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135', '138’, '139’, '140’, '141’, '142’, '143’ and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE, then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE
11/18/2022	3.0.5	Rule-7770	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 has a non-null value for WAIVER-TYPE then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type WAIVER-PARTICIPATION that matches on the join keys and (CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is between WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE) and CLAIM-HEADER-RECORD-IP.WAIVER-TYPE is equal to WAIVER-PARTICIPATION.WAIVER-TYPE
11/18/2022	3.0.5	Rule-7771	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' and CLAIM-HEADER-RECORD-LT has a non-null value for WAIVER-TYPE then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type WAIVER-PARTICIPATION that matches on the join keys and (CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE is between WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE) and CLAIM-HEADER-RECORD-LT.WAIVER-TYPE is equal to WAIVER-PARTICIPATION.WAIVER-TYPE
11/18/2022	3.0.5	Rule-7772	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a non-null value for WAIVER-TYPE then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type WAIVER-PARTICIPATION that matches on the join keys and (CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE is between WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE)and CLAIM-HEADER-RECORD-OT.WAIVER-TYPE is equal to WAIVER-PARTICIPATION.WAIVER-TYPE
11/18/2022	3.0.5	Rule-7773	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a non-null value for WAIVER-TYPE then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type WAIVER-PARTICIPATION that matches on the join keys and (CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is between WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE)and CLAIM-HEADER-RECORD-RX.WAIVER-TYPE is equal to WAIVER-PARTICIPATION.WAIVER-TYPE
08/26/2022	3.0.2	RULE-1261	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and (((if CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE is non-null then (CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE <= Valid Values End-Date)) OR (if CLAIM-HEADER-RECORD-LT.MEDICAID-PAID-DATE is non-null then (CLAIM-HEADER-RECORD-LT.MEDICAID-PAID-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.MEDICAID-PAID-DATE <= Valid Values End-Date)))
08/26/2022	3.0.2	RULE-1695	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE'and (((if CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE is non-nullthen (CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE <= Valid Values End-Date)) OR (if CLAIM-HEADER-RECORD-OT.MEDICAID-PAID-DATE is non-null then (CLAIM-HEADER-RECORD-OT.MEDICAID-PAID-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.MEDICAID-PAID-DATE <= Valid Values End-Date)))
08/26/2022	3.0.2	RULE-1959	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE'and (((if CLAIM-LINE-RECORD-RX.ADJUDICATION-DATE is non-nullthen (CLAIM-LINE-RECORD-RX.ADJUDICATION-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.ADJUDICATION-DATE <= Valid Values End-Date)) OR (if CLAIM-HEADER-RECORD-RX.MEDICAID-PAID-DATE is non-null then (CLAIM-HEADER-RECORD-RX.MEDICAID-PAID-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.MEDICAID-PAID-DATE <= Valid Values End-Date)))
08/26/2022	3.0.2	RULE-828	UPDATE	Data Dictionary - Validation Rules	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 field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date	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 field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE'and (((if CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE is non-nullthen (CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE <= Valid Values End-Date)) OR (if CLAIM-HEADER-RECORD-IP.MEDICAID-PAID-DATE is non-null then (CLAIM-HEADER-RECORD-IP.MEDICAID-PAID-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.MEDICAID-PAID-DATE <= Valid Values End-Date)))
08/26/2022	3.0.2	Rule-7710	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' 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-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE
08/26/2022	3.0.2	Rule-7711	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' 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-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE
08/26/2022	3.0.2	Rule-7712	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE
08/26/2022	3.0.2	Rule-7713	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE
08/26/2022	3.0.2	Rule-7719	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE- STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE
08/26/2022	3.0.2	Rule-7720	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE
08/26/2022	3.0.2	Rule-7721	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE
08/26/2022	3.0.2	Rule-7722	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE
08/26/2022	3.0.2	Rule-7723	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
08/26/2022	3.0.2	Rule-7724	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
08/26/2022	3.0.2	Rule-7725	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE'
08/26/2022	3.0.2	Rule-7726	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
08/26/2022	3.0.2	Rule-7714	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.PATIENT-STATUS does not equal '30' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for DISCHARGE-DATE
08/26/2022	3.0.2	Rule-7715	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: '3', 'C', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE
08/26/2022	3.0.2	Rule-7716	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-LINE-RECORD-IP.CLAIM-LINE-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: '3', 'C', then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE
08/26/2022	3.0.2	Rule-7717	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-LINE-RECORD-IP.CLAIM-LINE-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: '3', 'C', then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE
08/26/2022	3.0.2	Rule-7718	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for PRESCRIPTION-FILL-DATE
08/26/2022	3.0.2	N/A	ADD	Data Dictionary - Valid Values	PRESCRIPTION-ORIGIN-CODE.psv	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION PRESCRIPTION-ORIGIN-CODE\|00010101\|99991231\|0\|Not Known\|\| PRESCRIPTION-ORIGIN-CODE\|00010101\|99991231\|1\|Written\|Prescription obtained via paper.\| PRESCRIPTION-ORIGIN-CODE\|00010101\|99991231\|2\|Telephone\|Prescription obtained via oral instructions or interactive voice response using a phone.\| PRESCRIPTION-ORIGIN-CODE\|00010101\|99991231\|3\|Electronic\|Prescription obtained via SCRIPT or HL7 Standard transactions, or electronically within closed systems.\| PRESCRIPTION-ORIGIN-CODE\|00010101\|99991231\|4\|Facsimile\|Prescription obtained via transmission using a fax machine.\| PRESCRIPTION-ORIGIN-CODE\|00010101\|99991231\|5\|Pharmacy\|This value is used to cover any situation where a new Rx number needs to be created from an existing valid prescription such as traditional transfers, intrachain transfers, file buys, software upgrades/migrations, and any reason necessary to give it a new number. This value is also the appropriate value for Pharmacy dispensing when applicable such as BTC (behind the counter), Plan B, established protocols, pharmacists authority to prescribe, etc.\|
09/26/2022	3.0.3	N/A	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\| XIX-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|20211231\|49\|Other Care Services\|	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\| XIX-MBESCBES-CATEGORY-OF-SERVICE\|20221001\|99991231\|49\|Health Homes For Children With Medically Complex Conditions\|
09/26/2022	3.0.3	N/A	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\| XIX-MBESCBES-CATEGORY-OF-SERVICE\|20221001\|99991231\|7A7\|Drug Rebate Offset - Value Based Purchasing\|
08/26/2022	3.0.2	Rule-7729	ADD	Data Dictionary - Validation Rules	N/A	if PROV-LOCATION-AND-CONTACT-INFO has a non-null value for SUBMITTING-STATE-PROV-ID, then PROV-LOCATION-AND-CONTACT-INFO has a non-null value for ADDR-LN1
08/26/2022	3.0.2	Rule-7731	ADD	Data Dictionary - Validation Rules	N/A	if PROV-LOCATION-AND-CONTACT-INFO has a non-null value for ADDR-LN1, then PROV-LOCATION-AND-CONTACT-INFO has a non-null value for ADDR-CITY
08/26/2022	3.0.2	Rule-7732	ADD	Data Dictionary - Validation Rules	N/A	if PROV-LOCATION-AND-CONTACT-INFO has a non-null value for ADDR-LN1, then PROV-LOCATION-AND-CONTACT-INFO has a non-null value for ADDR-STATE
08/26/2022	3.0.2	Rule-7733	ADD	Data Dictionary - Validation Rules	N/A	if PROV-LOCATION-AND-CONTACT-INFO has a non-null value for ADDR-LN1, then PROV-LOCATION-AND-CONTACT-INFO has a non-null value for ADDR-ZIP-CODE
08/26/2022	3.0.2	Rule-7728	ADD	Data Dictionary - Validation Rules	N/A	if PROV-ATTRIBUTES-MAIN has a non-null value for SUBMITTING-STATE-PROV-ID and PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03,' then PROV-ATTRIBUTES-MAIN has a non-null value for PROV-LAST-NAME
10/07/2022	3.0.3	RULE-7737	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-LINE-RECORD-IP.CLAIM-LINE-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: '3', 'C', then CLAIM-LINE-RECORD-IP has a non-null value for TYPE-OF-SERVICE'
10/07/2022	3.0.3	RULE-7738	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' 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-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-LT has a non-null value for TYPE-OF-SERVICE'
10/07/2022	3.0.3	RULE-7739	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-OT has a non-null value for TYPE-OF-SERVICE'
10/07/2022	3.0.3	RULE-7740	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-RX has a non-null value for TYPE-OF-SERVICE'
10/07/2022	3.0.3	RULE-7736	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'
09/26/2022	3.0.3	N/A	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|20221001\|99991231\|8A7\|Drug Rebate Offset - Value Based Purchasing\|
09/26/2022	3.0.3	N/A	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION IHS-SERVICE-IND\|20220624\|99991231\|0\|No IHS-SERVICE-IND\|20220624\|99991231\|1\|Yes
10/07/2022	3.0.3	Rule-7745	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-OT has a non-null value for PLACE-OF-SERVICE and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE
10/07/2022	3.0.3	Rule-7746	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL or CLAIM-HEADER-RECORD-OT has a non-null value for PLACE-OF-SERVICE
10/07/2022	3.0.3	Rule-7747	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL, then CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE
10/07/2022	3.0.3	Rule-7748	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE, then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL
10/07/2022	3.0.3	ELG040	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT\| ELG040\|CITIZENSHIP-IND\|Value must be in [0, 1] or not populated	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT\| ELG040\|CITIZENSHIP-IND\|Value must be in [0, 1, 2] or not populated
10/07/2022	3.0.3	Rule-7749	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: ' '3', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODEor CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE
10/07/2022	3.0.3	Rule-7750	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-RX has a non-null value for DAYS-SUPPLY
10/07/2022	3.0.3	Rule-7751	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-RX has a non-null value for PRESCRIPTION-QUANTITY-ACTUAL
11/18/2022	3.0.5	MCR020	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| MCR020\|MANAGED-CARE-CONTRACT-EFF-DATE\|The first calendar day on which all of the other data elements in the same segment were effective.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| MCR020\|MANAGED-CARE-CONTRACT-EFF-DATE\|The start date of the managed care contract period with the state.
10/28/2022	3.0.4	CIP099, CLT051, COT036, CRX028	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| CIP099\|MEDICAID-PAID-DATE\|The date Medicaid paid this claim or adjustment. CLT051\|MEDICAID-PAID-DATE\|The date Medicaid paid this claim or adjustment. COT036\|MEDICAID-PAID-DATE\|The date Medicaid paid this claim or adjustment. CRX028\|MEDICAID-PAID-DATE\|The date Medicaid paid this claim or adjustment.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| CIP099\|MEDICAID-PAID-DATE\|The date Medicaid paid this claim or adjustment. For Encounter Records (Type of Claim = 3, C, W), the date the managed care organization paid the provider for the claim or adjustment. CLT051\|MEDICAID-PAID-DATE\|The date Medicaid paid this claim or adjustment. For Encounter Records (Type of Claim = 3, C, W), the date the managed care organization paid the provider for the claim or adjustment. COT036\|MEDICAID-PAID-DATE\|The date Medicaid paid this claim or adjustment. For Encounter Records (Type of Claim = 3, C, W), the date the managed care organization paid the provider for the claim or adjustment. CRX028\|MEDICAID-PAID-DATE\|The date Medicaid paid this claim or adjustment. For Encounter Records (Type of Claim = 3, C, W), the date the managed care organization paid the provider for the claim or adjustment.
10/07/2022	3.0.3	CIP293, CLT240, COT231, CRX164	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| CIP293\|TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT\|The total copayment amount on a claim that the beneficiary is obligated to pay for covered services. This is the total Medicaid or contract negotiated beneficiary copayment liability for covered service on the claim. Do not subtract out any payments made toward the copayment. CLT240\|TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT\|The total copayment amount on a claim that the beneficiary is obligated to pay for covered services. This is the total Medicaid or contract negotiated beneficiary copayment liability for covered service on the claim. Do not subtract out any payments made toward the copayment. COT231\|TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT\|The total copayment amount on a claim that the beneficiary is obligated to pay for covered services. This is the total Medicaid or contract negotiated beneficiary copayment liability for covered service on the claim. Do not subtract out any payments made toward the copayment. CRX164\|TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT\|The total copayment amount on a claim that the beneficiary is obligated to pay for covered services. This is the total Medicaid or contract negotiated beneficiary copayment liability for covered service on the claim. Do not subtract out any payments made toward the copayment.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| CIP293\|TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT\|The total coinsurance amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary coinsurance liability for covered services on the claim. Do not subtract out any payments made toward the coinsurance. CLT240\|TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT\|The total coinsurance amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary coinsurance liability for covered services on the claim. Do not subtract out any payments made toward the coinsurance. COT231\|TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT\|The total coinsurance amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary coinsurance liability for covered services on the claim. Do not subtract out any payments made toward the coinsurance. CRX164\|TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT\|The total coinsurance amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary coinsurance liability for covered services on the claim. Do not subtract out any payments made toward the coinsurance.
10/07/2022	3.0.3	CIP294, CLT241, COT232, CRX165	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| CIP294\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible. CLT241\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible. COT232\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible. CRX165\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| CIP294\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability minus previous beneficiary payments that went toward their deductible. Do not subtract out any payments for the given claim that went toward the deductible. CLT241\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability minus previous beneficiary payments that went toward their deductible. Do not subtract out any payments for the given claim that went toward the deductible. COT232\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability minus previous beneficiary payments that went toward their deductible. Do not subtract out any payments for the given claim that went toward the deductible. CRX165\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability minus previous beneficiary payments that went toward their deductible. Do not subtract out any payments for the given claim that went toward the deductible.
10/07/2022	3.0.3	PRV024	ADD	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| PRV024\|PROV-ORGANIZATION-NAME\|The name of the provider when the provider is an organization. If the provider organization name exceeds 60 characters submit only the first 60 characters of the name.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| PRV024\|PROV-ORGANIZATION-NAME\|The name of the provider when the provider is an organization. If the provider organization name exceeds 60 characters submit only the first 60 characters of the name. Provider Organization Name should be same as provider last name when provider is an individual.
10/28/2022	3.0.4	ELG095	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| ELG095\|ELIGIBILITY-CHANGE-REASON\|The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| ELG095\|ELIGIBILITY-CHANGE-REASON\|The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another.
11/18/2022	3.0.5	Rule-7768	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals 'G', then ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '03', '06'
10/28/2022	3.0.4	RULE-7752	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.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE
10/28/2022	3.0.4	RULE-7755	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE
10/28/2022	3.0.4	RULE-7754	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4',then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE
10/28/2022	3.0.4	RULE-7753	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE
11/18/2022	3.0.5	Rule-7760	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.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM'
11/18/2022	3.0.5	Rule-7761	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI'
11/18/2022	3.0.5	Rule-7762	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM'
11/18/2022	3.0.5	Rule-7756	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.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NUM
11/18/2022	3.0.5	Rule-7757	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NUM
11/18/2022	3.0.5	Rule-7758	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM
11/18/2022	3.0.5	Rule-7759	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NUM
11/18/2022	3.0.5	Rule-7766	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3','C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM or CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM
11/18/2022	3.0.5	Rule-7767	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' then CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NPI-NUM or CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NUM
11/18/2022	3.0.5	ELG097	ADD	Data Dictionary	N/A	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT\| ELG097\|RESTRICTED-BENEFITS-CODE\|(Restricted Benefits) if value is "G", then Dual Eligible Code (ELG.005.085) must be in (‘01’, ‘03', ‘06’)
11/18/2022	3.0.5	ELG270	ADD	Data Dictionary	N/A	DE NO\| DATA ELEMENT NAME COMPUTING\|CODING REQUIREMENT\| ELG270\|LOCKED-IN-SRVCS\|Must be a 3 digit value from the Type-of-Service valid value list
11/18/2022	3.0.5	Rule-7769	ADD	Data Dictionary - Validation Rules	N/A	If the field is populated, the value must be contained in the set of valid values with id: ‘TYPE-OF-SERVICE’ and (if LOCK-IN-INFORMATION.LOCKIN-EFF-DATE is non-null then LOCK-IN-INFORMATION.LOCKIN-EFF-DATE >= Valid Values Effective-Date and LOCK-IN-INFORMATION.LOCKIN-EFF-DATE <= Valid Values End-Date)
11/18/2022	3.0.5	Rule-7583	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.CLAIM-STATUS is not equal to one of the following: ‘26', ‘026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', D', 'X' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654',then CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is not equal to the one of following: '123’, '135'	N/A
11/18/2022	3.0.5	Rule-7585	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal ‘0'and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: ‘26', ‘026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', D', 'X' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654',then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to the one of following: '123’, '131', '135'	N/A
11/18/2022	3.0.5	Rule-7586	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal ‘0'and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: ‘26', ‘026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', D', 'X' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654',then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is not equal to '131'	N/A
11/18/2022	3.0.5	Rule-7763	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM'
11/18/2022	3.0.5	Rule-7764	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-LINE-RECORD-IP.CLAIM-LINE-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: '3', 'C', then CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NPI-NUM'
11/18/2022	3.0.5	Rule-7765	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' 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-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NPI-NUM'
12/30/2022	3.1.0	IHS-SERVICE-IND (CIP296, CLT243, COT234, CRX172)	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| CIP296\|IHS-SERVICE-IND\|This data element indicates services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes. CLT243\|IHS-SERVICE-IND\|This data element indicates services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes. COT234\|IHS-SERVICE-IND\|This data element indicates services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes. CRX172\|IHS-SERVICE-IND\|This data element indicates services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| CIP296\|IHS-SERVICE-IND\|To indicate Services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes. CLT243\|IHS-SERVICE-IND\|To indicate Services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes. COT234\|IHS-SERVICE-IND\|To indicate Services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes. CRX172\|IHS-SERVICE-IND\|To indicate Services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes.
04/13/2018	2.2.0	RULE-1658	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does not equal '585' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TOOTH-QUAD-CODE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '013', '029'	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TOOTH-QUAD-CODE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '013', '029', '035'
12/09/2022	3.0.6	Rule-7774	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.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then (CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT does not equal '0.00')'
12/09/2022	3.0.6	Rule-7775	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then (CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT does not equal '0.00')'
12/09/2022	3.0.6	Rule-7776	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then (CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT does not equal '0.00')'
12/09/2022	3.0.6	Rule-7777	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4'and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '1'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A'then (CLAIM-LINE-RECORD-RX has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT does not equal '0.00')or (CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT does not equal '0.00')or (CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT does not equal '0.00')'
12/09/2022	3.0.6	Rule-7778	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.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then (CLAIM-HEADER-RECORD-IP has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')
12/09/2022	3.0.6	Rule-7779	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then (CLAIM-HEADER-RECORD-LT has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT equals '0.00') and (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') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'
12/09/2022	3.0.6	Rule-7780	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then (CLAIM-LINE-RECORD-OT has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'
12/09/2022	3.0.6	Rule-7781	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then (CLAIM-LINE-RECORD-RX has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'
12/09/2022	3.0.6	RULE-7782	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 is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys
12/09/2022	3.0.6	RULE-7783	ADD	Data Dictionary - Validation Rules	N/A	f 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 is equal to one of the following: '1', 'A' 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.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys
12/09/2022	3.0.6	RULE-7784	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to one of the following: '1', then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys
12/09/2022	3.0.6	RULE-7785	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys
12/09/2022	3.0.6	IHS-SERVICE-IND (CIP296, CLT243, COT234, CRX172)	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| IHS-SERVICE-IND\|20220624\|99991231\|0\|No IHS-SERVICE-IND\|20220624\|99991231\|1\|Yes	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| IHS-SERVICE-IND\|00010101\|99991231\|0\|No IHS-SERVICE-IND\|00010101\|99991231\|1\|Yes
12/30/2022	3.1.0	RULE-7786	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: ''1', 'A' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-BILLED-AMT
12/30/2022	3.1.0	RULE-7787	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.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-BILLED-AMT
12/30/2022	3.1.0	RULE-7788	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-BILLED-AMT
12/30/2022	3.1.0	RULE-7789	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-BILLED-AMT
12/30/2022	3.1.0	RULE-7790	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.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-IP.PAYMENT-LEVEL-IND equals '2', then CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-IP.MEDICAID-PAID-AMT values, where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
12/30/2022	3.1.0	RULE-7791	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-LT.PAYMENT-LEVEL-IND equals '2', then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT values, where CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
12/30/2022	3.1.0	RULE-7792	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-OT.PAYMENT-LEVEL-IND equals '2', then CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT values, where CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
12/30/2022	3.1.0	RULE-7793	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-RX.PAYMENT-LEVEL-IND equals '2', then CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-RX.MEDICAID-PAID-AMT values, where CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
12/30/2022	3.1.0	RULE-7794	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.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-IP has a non-null value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-IP.TOT-ALLOWED-AMT does not equal '0.00' and CLAIM-HEADER-RECORD-IP has a non-null value for TOT-ALLOWED-AMT, then CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-IP.TOT-ALLOWED-AMT
12/30/2022	3.1.0	RULE-7795	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-LT has a non-null value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT does not equal '0.00' and CLAIM-HEADER-RECORD-LT has a non-null value for TOT-ALLOWED-AMT, then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT
12/30/2022	3.1.0	RULE-7796	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-OT has a non-null value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-ALLOWED-AMT does not equal '0.00' and CLAIM-HEADER-RECORD-OT has a non-null value for TOT-ALLOWED-AMT, then CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-OT.TOT-ALLOWED-AMT
12/30/2022	3.1.0	RULE-7798	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' 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-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE
12/30/2022	3.1.0	RULE-7797	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' 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-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE
12/30/2022	3.1.0	RULE-7800	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE
12/30/2022	3.1.0	RULE-7799	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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE
12/30/2022	3.1.0	RULE-7801	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE
12/30/2022	3.1.0	RULE-7802	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE
12/30/2022	3.1.0	RULE-7803	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE
12/30/2022	3.1.0	RULE-7804	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE
12/30/2022	3.1.0	Rule-7805	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.PATIENT-STATUS does not equal '30' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for DISCHARGE-DATE
12/30/2022	3.1.0	Rule-7806	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: '1', 'A', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE
12/30/2022	3.1.0	Rule-7807	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-LINE-RECORD-IP.CLAIM-LINE-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: '1', 'A', then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE
12/30/2022	3.1.0	Rule-7808	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-LINE-RECORD-IP.CLAIM-LINE-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: '1', 'A', then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE
12/30/2022	3.1.0	Rule-7809	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for PRESCRIPTION-FILL-DATE
12/30/2022	3.1.0	RULE-7810	ADD	Data Dictionary - Validation Rules	N/A	if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to 'D' and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type MFP-INFORMATION that matches on the join keys and (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE >= MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= MFP-INFORMATION.MFP-ENROLLMENT-END-DATE)
12/30/2022	3.1.0	RULE-7430	UPDATE	Data Dictionary - Validation Rules	if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals 'D'and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1',then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keysand (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE)	N/A
01/27/2023	3.2.0	Rule-7811	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A'and CLAIM-HEADER-RECORD-OT has a non-null value for PLACE-OF-SERVICEand CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE
01/27/2023	3.2.0	Rule-7812	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL or CLAIM-HEADER-RECORD-OT has a non-null value for PLACE-OF-SERVICE
01/27/2023	3.2.0	Rule-7813	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL, then CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE
01/27/2023	3.2.0	Rule-7814	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 1', 'A' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE, then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL
01/27/2023	3.2.0	Rule-7815	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE or CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE
01/27/2023	3.2.0	Rule-7816	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-RX has a non-null value for DAYS-SUPPLY
01/27/2023	3.2.0	Rule-7817	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-RX has a non-null value for PRESCRIPTION-QUANTITY-ACTUAL
01/27/2023	3.2.0	Rule-7818	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.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM'
01/27/2023	3.2.0	Rule-7819	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI'
01/27/2023	3.2.0	Rule-7820	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM'
01/27/2023	3.2.0	Rule-7821	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.TYPE-OF-CLAIM is equal to one of the following: '1', 'A’ and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NUM
01/27/2023	3.2.0	Rule-7822	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' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A’ and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NUM
01/27/2023	3.2.0	Rule-7823	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A’ and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM
01/27/2023	3.2.0	Rule-7824	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A’ and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NUM
01/27/2023	3.2.0	Rule-7825	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NPI-NUM or CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NUM
01/27/2023	3.2.0	Rule-7826	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','A' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM or CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM
01/27/2023	3.2.0	Rule-7827	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM
01/27/2023	3.2.0	Rule-7828	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-LINE-RECORD-IP.CLAIM-LINE-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: '1', 'A', then CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NPI-NUM
01/27/2023	3.2.0	Rule-7829	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' 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-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NPI-NUM
01/27/2023	3.2.0	RULE-2432	UPDATE	Data Dictionary - Validation Rules	if RACE-INFORMATION.RACE is equal to one of the following: '010', '015', then RACE-INFORMATION has a valid, non-null value for RACE-OTHER	if RACE-INFORMATION.RACE is equal to one of the following: '010', '015', '018’, then RACE-INFORMATION has a valid, non-null value for RACE-OTHER
01/27/2023	3.2.0	RULE-7537	UPDATE	Data Dictionary - Validation Rules	if RACE-INFORMATION.RACE is not equal to one of the following: '010', '015', then RACE-INFORMATION has a null value for RACE-OTHER	if RACE-INFORMATION.RACE is not equal to one of the following: ‘010', '015', '018’, then RACE-INFORMATION has a null value for RACE-OTHER
06/08/2018	2.3.0	RULE-1630	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does not equal '585' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE	'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE
06/08/2018	2.3.0	RULE-1624	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does not equal '585' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE
05/11/2018	2.2.0	RULE-7167	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then when CLAIM-HEADER-RECORD-IP.DIAGNOSIS-RELATED-GROUP-IND is a CMS DRG Grouper, as specified by prefix 'HG', CLAIM-HEADER-RECORD-IP.DIAGNOSIS-RELATED-GROUP must be a valid value. We support valid values in 'MS-DRG-VERSION-11', 'MS-DRG-VERSION-12', 'MS-DRG-VERSION-13', 'MS-DRG-VERSION-14', 'MS-DRG-VERSION-15', 'MS-DRG-VERSION-16', 'MS-DRG-VERSION-17', 'MS-DRG-VERSION-18', 'MS-DRG-VERSION-19', 'MS-DRG-VERSION-20', 'MS-DRG-VERSION-21', 'MS-DRG-VERSION-22', 'MS-DRG-VERSION-23', 'MS-DRG-VERSION-24', 'MS-DRG-VERSION-25', 'MS-DRG-VERSION-26', 'MS-DRG-VERSION-27', 'MS-DRG-VERSION-28', 'MS-DRG-VERSION-29', 'MS-DRG-VERSION-30', 'MS-DRG-VERSION-31', 'MS-DRG-VERSION-32', or 'MS-DRG-VERSION-33'.	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then when CLAIM-HEADER-RECORD-IP.DIAGNOSIS-RELATED-GROUP-IND is a CMS DRG Grouper, as specified by prefix 'HG', CLAIM-HEADER-RECORD-IP.DIAGNOSIS-RELATED-GROUP must be a valid value. We support valid values in 'MS-DRG-VERSION-3', 'MS-DRG-VERSION-4', 'MS-DRG-VERSION-5', 'MS-DRG-VERSION-6', 'MS-DRG-VERSION-7', 'MS-DRG-VERSION-8', 'MS-DRG-VERSION-9', 'MS-DRG-VERSION-10', 'MS-DRG-VERSION-11', 'MS-DRG-VERSION-12', 'MS-DRG-VERSION-13', 'MS-DRG-VERSION-14', 'MS-DRG-VERSION-15', 'MS-DRG-VERSION-16', 'MS-DRG-VERSION-17', 'MS-DRG-VERSION-18', 'MS-DRG-VERSION-19', 'MS-DRG-VERSION-20', 'MS-DRG-VERSION-21', 'MS-DRG-VERSION-22', 'MS-DRG-VERSION-23', 'MS-DRG-VERSION-24', or 'MS-DRG-VERSION-25'
12/04/2020	2.4.0	CITIZENSHIP-IND	UPDATE	Data Dictionary - Valid Values	\|Value ID\|Effective Date\|End Date\|Value\|Description\| \|CITIZENSHIP-IND\|00010101\|99991231\|0\|No\| \|CITIZENSHIP-IND\|00010101\|99991231\|1\|Yes\|	\|Value ID\|Effective Date\|End Date\|Value\|Description\| \|CITIZENSHIP-IND\|00010101\|99991231\|0\|Non-citizen\| \|CITIZENSHIP-IND\|00010101\|99991231\|1\|U.S. Citizen\| \|CITIZENSHIP-IND\|00010101\|99991231\|2\|U.S. National\|
12/04/2020	2.4.0	IMMIGRATION-STATUS	UPDATE	Data Dictionary - Valid Values	\|Value ID\|Effective Date\|End Date\|Value\|Description\| \|IMMIGRATION-STATUS\|00010101\|99991231\|1\|Qualified non-citizen\| \|IMMIGRATION-STATUS\|00010101\|99991231\|2\|Lawfully present under CHIPRA 214\| \|IMMIGRATION-STATUS\|00010101\|99991231\|3\|Eligible only for payment for emergency services\| \|IMMIGRATION-STATUS\|00010101\|99991231\|8\|Not Applicable (U.S. citizen)\|	\|Value ID\|Effective Date\|End Date\|Value\|Description\| \|IMMIGRATION-STATUS\|00010101\|99991231\|1\|Qualified non-citizen\| \|IMMIGRATION-STATUS\|00010101\|99991231\|2\|Lawfully present under CHIPRA 214\| \|IMMIGRATION-STATUS\|00010101\|99991231\|3\|Eligible only for payment for emergency services\| \|IMMIGRATION-STATUS\|00010101\|99991231\|8\|Not Applicable (U.S. citizen or U.S. national)\|
11/23/2018	2.3.0	ADJUSTMENT-IND	UPDATE	Data Dictionary - Valid Values	N/A	Valid values for ADJUSTMENT-IND has been updated per T-MSIS DD 2.1. As per DD 2.1 the Valid values are: 0 Original Claim/Encounter/Payment 1 Void/Reversal/Cancel of a prior submission 4 Replacement/Resubmission of a previously paid/approved claim/encounter/payment 5 Credit Gross Adjustment 6 Debit Gross Adjustment
04/13/2018	2.2.0	RULE-2165	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ELIGIBILITY-DETERMINANT-EFF-DATE. End date field: ELIGIBILITY-DETERMINANT-END-DATE	N/A
08/30/2018	2.3.0	RULE-982	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is greater than zero or CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is less than or equal to CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is greater than zero or CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is less than CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT
06/22/2018	2.3.0	RULE-982	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is greater than zero or CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is less than CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is greater than zero or CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is less than or equal to CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT
01/31/2020	2.4.0	RULE-325	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-336	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CROSSOVER-INDICATOR''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CROSSOVER-INDICATOR' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-337	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-HOSPITAL''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-HOSPITAL' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-338	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-340	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND''	If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-341	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-342	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ADMISSION-TYPE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ADMISSION-TYPE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-346	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-349	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-350	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-355	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-356	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-361	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-362	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-367	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-368	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-373	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-374	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-379	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-384	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-389	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-394	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-399	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-404	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-409	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-416	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-418	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-429	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-431	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-442	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-444	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-455	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-458	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-469	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-471	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-482	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-484	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-496	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HOUR''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HOUR' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-503	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HOUR''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HOUR' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-510	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-CLAIM''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-CLAIM' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-511	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-IP.TYPE-OF-BILL is a valid type of bill code'	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-IP.TYPE-OF-BILL is a valid type of bill code and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-512	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-513	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS-CATEGORY''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS-CATEGORY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-514	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SOURCE-LOCATION''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SOURCE-LOCATION' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-518	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ALLOWED-CHARGE-SRC''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ALLOWED-CHARGE-SRC' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-520	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-522	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-525	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-528	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-549	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-INSURANCE-IND''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-INSURANCE-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-550	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-551	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SERVICE-TRACKING-TYPE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SERVICE-TRACKING-TYPE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-555	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FIXED-PAYMENT-IND''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FIXED-PAYMENT-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-556	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-CODE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-557	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-SOURCE-NONFEDERAL-SHARE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-SOURCE-NONFEDERAL-SHARE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-558	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-COMB-DED-IND''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-COMB-DED-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-560	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-569	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PAYMENT-LEVEL-IND''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PAYMENT-LEVEL-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-570	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-REIM-TYPE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-REIM-TYPE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-578	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FORCED-CLAIM-IND''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FORCED-CLAIM-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-579	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-CARE-ACQUIRED-CONDITION-IND''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-CARE-ACQUIRED-CONDITION-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-580	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-581	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-582	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-583	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-584	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-585	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-586	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-587	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-588	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-589	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-679	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-PROV-IND''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-PROV-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-681	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-693	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'
01/31/2020	2.4.0	RULE-694	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-695	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-699	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-700	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-701	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-705	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-706	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-707	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-714	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OUTLIER-CODE''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OUTLIER-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-718	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PATIENT-STATUS''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PATIENT-STATUS' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-723	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SPLIT-CLAIM-IND''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SPLIT-CLAIM-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-724	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'BORDER-STATE-IND''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'BORDER-STATE-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-734	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-DENIED-INDICATOR''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-DENIED-INDICATOR' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-736	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-IND''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-750	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-753	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-756	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-761	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-774	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'.	If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'. and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-776	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE''	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 field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-778	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS''	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 field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-792	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE''	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 field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-793	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE''	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 field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-805	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'BILLING-UNIT''	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 field is populated, the value must be contained in the set of valid values with id: 'BILLING-UNIT' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-806	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE''	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 field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-814	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	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 field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-815	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE''	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 field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-816	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY''	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 field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-820	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION''	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 field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-821	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'PROV-FACILITY-TYPE''	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 field is populated, the value must be contained in the set of valid values with id: 'PROV-FACILITY-TYPE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-822	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE''	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 field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-823	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT''	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 field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-826	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE''	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 field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-828	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE''	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 field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-837	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE''	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 field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-842	UPDATE	Data Dictionary - Validation Rules	'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 field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE''	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 field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-7127	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-7128	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-7129	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-7130	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-7131	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-7132	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-7133	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))
01/31/2020	2.4.0	RULE-874	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-885	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CROSSOVER-INDICATOR''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CROSSOVER-INDICATOR' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-886	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-888	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND''	If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-889	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-891	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-894	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-895	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-900	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-901	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-906	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-907	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-912	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-913	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-918	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-919	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-925	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HOUR''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HOUR' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-931	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HOUR''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HOUR' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-951	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-CLAIM''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-CLAIM' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-952	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-LT.TYPE-OF-BILL is a valid type of bill code'	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-LT.TYPE-OF-BILL is a valid type of bill code' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-953	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-954	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS-CATEGORY''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS-CATEGORY' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-955	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SOURCE-LOCATION''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SOURCE-LOCATION' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-959	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-961	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-964	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-967	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-988	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-INSURANCE-IND''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-INSURANCE-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-989	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-990	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SERVICE-TRACKING-TYPE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SERVICE-TRACKING-TYPE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-994	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FIXED-PAYMENT-IND''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FIXED-PAYMENT-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-995	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-996	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-SOURCE-NONFEDERAL-SHARE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-SOURCE-NONFEDERAL-SHARE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-997	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-COMB-DED-IND''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-COMB-DED-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-999	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1008	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PAYMENT-LEVEL-IND''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PAYMENT-LEVEL-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1009	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-REIM-TYPE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-REIM-TYPE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1017	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FORCED-CLAIM-IND''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FORCED-CLAIM-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1018	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-CARE-ACQUIRED-CONDITION-IND''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-CARE-ACQUIRED-CONDITION-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1019	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1020	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1021	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1022	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1023	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1024	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1025	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1026	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1027	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1028	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1117	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-PROV-IND''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-PROV-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1119	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1130	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' 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)'
01/31/2020	2.4.0	RULE-1131	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1132	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1136	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1137	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1138	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1141	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PATIENT-STATUS''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PATIENT-STATUS' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1156	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SPLIT-CLAIM-IND''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SPLIT-CLAIM-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1157	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'BORDER-STATE-IND''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'BORDER-STATE-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1167	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-DENIED-INDICATOR''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-DENIED-INDICATOR' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1169	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-IND''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1183	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1186	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1191	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1192	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1193	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1197	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1211	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'.	If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'. and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1213	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1215	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1228	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1229	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1242	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BILLING-UNIT''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BILLING-UNIT' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1243	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1250	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1251	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1252	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1253	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1254	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1255	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1258	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-FACILITY-TYPE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-FACILITY-TYPE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1259	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1261	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1267	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1274	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE''	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1327	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1338	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CROSSOVER-INDICATOR''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CROSSOVER-INDICATOR' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1339	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1341	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND''	If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1342	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1345	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1346	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1350	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1351	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1370	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-CLAIM''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-CLAIM' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1371	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-OT.TYPE-OF-BILL is a valid type of bill code'	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-OT.TYPE-OF-BILL is a valid type of bill code' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1372	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1373	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS-CATEGORY''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS-CATEGORY' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1374	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SOURCE-LOCATION''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SOURCE-LOCATION' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1378	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1380	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1383	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1386	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1407	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-INSURANCE-IND''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-INSURANCE-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1408	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1409	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SERVICE-TRACKING-TYPE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SERVICE-TRACKING-TYPE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1413	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FIXED-PAYMENT-IND''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FIXED-PAYMENT-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1414	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-CODE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1415	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-SOURCE-NONFEDERAL-SHARE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-SOURCE-NONFEDERAL-SHARE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1416	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-COMB-DED-IND''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1418	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1427	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PAYMENT-LEVEL-IND''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PAYMENT-LEVEL-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1428	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-REIM-TYPE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-REIM-TYPE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1431	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FORCED-CLAIM-IND''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FORCED-CLAIM-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1432	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-CARE-ACQUIRED-CONDITION-IND''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-CARE-ACQUIRED-CONDITION-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1433	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1434	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1435	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1436	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1437	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1438	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1439	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1440	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1441	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1442	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1531	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-PROV-IND''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-PROV-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1533	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1545	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
01/31/2020	2.4.0	RULE-1547	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1548	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1553	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1555	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1556	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1559	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PLACE-OF-SERVICE''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PLACE-OF-SERVICE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1565	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'BORDER-STATE-IND''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'BORDER-STATE-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1575	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-DENIED-INDICATOR''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-DENIED-INDICATOR' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1577	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-IND''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1595	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1599	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1603	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1616	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'.	If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1618	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1620	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1633	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1641	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1642	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1644	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1655	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1660	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-TAXONOMY''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-TAXONOMY' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1669	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1671	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1672	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1673	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1674	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-DESIGNATION-SYSTEM''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-DESIGNATION-SYSTEM' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1675	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-NUM''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-NUM' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1676	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-QUAD-CODE''	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-QUAD-CODE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1677	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-SURFACE-CODE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-SURFACE-CODE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1681	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1687	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1689	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1690	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1693	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1695	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1703	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1706	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1713	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1715	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1718	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-7134	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-SERVICE-CODE''	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-SERVICE-CODE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1749	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1759	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CROSSOVER-INDICATOR''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CROSSOVER-INDICATOR' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1760	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1762	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND''	If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1769	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-CLAIM''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-CLAIM' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1770	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1771	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS-CATEGORY''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS-CATEGORY' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1772	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SOURCE-LOCATION''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SOURCE-LOCATION' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1776	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1778	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1781	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1784	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1805	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-INSURANCE-IND''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-INSURANCE-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1806	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1807	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SERVICE-TRACKING-TYPE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SERVICE-TRACKING-TYPE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1811	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FIXED-PAYMENT-IND''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FIXED-PAYMENT-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1812	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-CODE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-CODE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1813	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-SOURCE-NONFEDERAL-SHARE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-SOURCE-NONFEDERAL-SHARE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1814	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1823	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PAYMENT-LEVEL-IND''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PAYMENT-LEVEL-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1824	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-REIM-TYPE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-REIM-TYPE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1827	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FORCED-CLAIM-IND''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FORCED-CLAIM-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1836	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-PROV-IND''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-PROV-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1838	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1849	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
01/31/2020	2.4.0	RULE-1850	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1854	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1855	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1856	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1860	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'BORDER-STATE-IND''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'BORDER-STATE-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1872	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COMPOUND-DRUG-IND''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COMPOUND-DRUG-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1881	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-DENIED-INDICATOR''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-DENIED-INDICATOR' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1883	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-IND''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1894	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1902	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1916	UPDATE	Data Dictionary - Validation Rules	If the LINE-ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'.	If the LINE-ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1920	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1936	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'UNIT-OF-MEASURE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'UNIT-OF-MEASURE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1937	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1940	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-SERVICE-CODE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-SERVICE-CODE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1941	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-TAXONOMY''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-TAXONOMY' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1942	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1944	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NEW-REFILL-IND''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NEW-REFILL-IND' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1945	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BRAND-GENERIC-IND''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BRAND-GENERIC-IND' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1950	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'COMPOUND-DOSAGE-FORM''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'COMPOUND-DOSAGE-FORM' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1951	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REBATE-ELIGIBLE-INDICATOR''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REBATE-ELIGIBLE-INDICATOR' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1952	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1953	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1954	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1957	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1959	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1968	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-1970	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-COMB-DED-IND''	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-COMB-DED-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2003	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2012	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'SEX''	If the field is populated, the value must be contained in the set of valid values with id: 'SEX' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2036	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2043	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'SSN-VERIFICATION-FLAG''	If the field is populated, the value must be contained in the set of valid values with id: 'SSN-VERIFICATION-FLAG' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2044	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'INCOME-CODE''	If the field is populated, the value must be contained in the set of valid values with id: 'INCOME-CODE' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2045	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'VETERAN-IND''	If the field is populated, the value must be contained in the set of valid values with id: 'VETERAN-IND' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2047	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'CITIZENSHIP-IND''	If the field is populated, the value must be contained in the set of valid values with id: 'CITIZENSHIP-IND' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2049	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'CITIZENSHIP-VERIFICATION-FLAG''	If the field is populated, the value must be contained in the set of valid values with id: 'CITIZENSHIP-VERIFICATION-FLAG' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2050	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'IMMIGRATION-STATUS''	If the field is populated, the value must be contained in the set of valid values with id: 'IMMIGRATION-STATUS' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2052	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'IMMIGRATION-VERIFICATION-FLAG''	If the field is populated, the value must be contained in the set of valid values with id: 'IMMIGRATION-VERIFICATION-FLAG' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2057	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'PRIMARY-LANGUAGE-ENGL-PROF-CODE''	If the field is populated, the value must be contained in the set of valid values with id: 'PRIMARY-LANGUAGE-ENGL-PROF-CODE' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2059	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'PRIMARY-LANGUAGE-CODE''	If the field is populated, the value must be contained in the set of valid values with id: 'PRIMARY-LANGUAGE-CODE' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2061	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'HOUSEHOLD-SIZE''	If the field is populated, the value must be contained in the set of valid values with id: 'HOUSEHOLD-SIZE' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2062	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'PREGNANCY-IND''	If the field is populated, the value must be contained in the set of valid values with id: 'PREGNANCY-IND' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2067	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'CHIP-CODE''	If the field is populated, the value must be contained in the set of valid values with id: 'CHIP-CODE' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2080	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and ELIGIBLE-CONTACT-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2087	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'ELIGIBLE-ADDR-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'ELIGIBLE-ADDR-TYPE' and ELIGIBLE-CONTACT-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2096	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and ELIGIBLE-CONTACT-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2098	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'COUNTY''	If the field is populated, the value must be contained in the set of valid values with id: 'COUNTY' and ELIGIBLE-CONTACT-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2114	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2122	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'MEDICAID-BASIS-OF-ELIGIBILITY''	If the field is populated, the value must be contained in the set of valid values with id: 'MEDICAID-BASIS-OF-ELIGIBILITY' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2126	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'DUAL-ELIGIBLE-CODE''	If the field is populated, the value must be contained in the set of valid values with id: 'DUAL-ELIGIBLE-CODE' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2132	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'PRIMARY-ELIGIBILITY-GROUP-IND''	If the field is populated, the value must be contained in the set of valid values with id: 'PRIMARY-ELIGIBILITY-GROUP-IND' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2135	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'ELIGIBILITY-GROUP''	If the field is populated, the value must be contained in the set of valid values with id: 'ELIGIBILITY-GROUP' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2136	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'LEVEL-OF-CARE-STATUS''	If the field is populated, the value must be contained in the set of valid values with id: 'LEVEL-OF-CARE-STATUS' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2137	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'SSDI-IND''	If the field is populated, the value must be contained in the set of valid values with id: 'SSDI-IND' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2138	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'SSI-IND''	If the field is populated, the value must be contained in the set of valid values with id: 'SSI-STATE-SUPPLEMENT-STATUS-CODE' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2140	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'SSI-STATE-SUPPLEMENT-STATUS-CODE''	If the field is populated, the value must be contained in the set of valid values with id: 'SSI-STATE-SUPPLEMENT-STATUS-CODE' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2142	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'SSI-STATUS''	If the field is populated, the value must be contained in the set of valid values with id: 'SSI-STATUS' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2144	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'STATE-SPEC-ELIG-GROUP''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE-SPEC-ELIG-GROUP' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2145	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'CONCEPTION-TO-BIRTH-IND''	If the field is populated, the value must be contained in the set of valid values with id: 'CONCEPTION-TO-BIRTH-IND' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2146	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'ELIGIBILITY-CHANGE-REASON''	If the field is populated, the value must be contained in the set of valid values with id: 'ELIGIBILITY-CHANGE-REASON' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2154	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'RESTRICTED-BENEFITS-CODE''	If the field is populated, the value must be contained in the set of valid values with id: 'RESTRICTED-BENEFITS-CODE' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2159	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'TANF-CASH-CODE''	If the field is populated, the value must be contained in the set of valid values with id: 'TANF-CASH-CODE' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2174	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and HEALTH-HOME-SPA-PARTICIPATION-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and HEALTH-HOME-SPA-PARTICIPATION-INFORMATION.HEALTH-HOME-SPA-PARTICIPATION-EFF-DATE must be >= Valid Values Effective-Date and HEALTH-HOME-SPA-PARTICIPATION-INFORMATION.HEALTH-HOME-SPA-PARTICIPATION-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2201	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and HEALTH-HOME-SPA-PROVIDERS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and HEALTH-HOME-SPA-PROVIDERS.HEALTH-HOME-SPA-PROVIDER-EFF-DATE must be >= Valid Values Effective-Date and HEALTH-HOME-SPA-PROVIDERS.HEALTH-HOME-SPA-PROVIDER-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2228	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and HEALTH-HOME-CHRONIC-CONDITIONS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and HEALTH-HOME-CHRONIC-CONDITIONS.HEALTH-HOME-CHRONIC-CONDITION-EFF-DATE must be >= Valid Values Effective-Date and HEALTH-HOME-CHRONIC-CONDITIONS.HEALTH-HOME-CHRONIC-CONDITION-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2235	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-CHRONIC-CONDITION''	If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-CHRONIC-CONDITION' and HEALTH-HOME-CHRONIC-CONDITIONS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and HEALTH-HOME-CHRONIC-CONDITIONS.HEALTH-HOME-CHRONIC-CONDITION-EFF-DATE must be >= Valid Values Effective-Date and HEALTH-HOME-CHRONIC-CONDITIONS.HEALTH-HOME-CHRONIC-CONDITION-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2250	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and LOCK-IN-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and LOCK-IN-INFORMATION.LOCKIN-EFF-DATE must be >= Valid Values Effective-Date and LOCK-IN-INFORMATION.LOCKIN-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2273	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MFP-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2280	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'MFP-LIVES-WITH-FAMILY''	If the field is populated, the value must be contained in the set of valid values with id: 'MFP-LIVES-WITH-FAMILY' and MFP-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2281	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'MFP-QUALIFIED-INSTITUTION''	If the field is populated, the value must be contained in the set of valid values with id: 'MFP-QUALIFIED-INSTITUTION' and MFP-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2282	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'MFP-QUALIFIED-RESIDENCE''	If the field is populated, the value must be contained in the set of valid values with id: 'MFP-QUALIFIED-RESIDENCE' and MFP-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2283	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'MFP-REASON-PARTICIPATION-ENDED''	If the field is populated, the value must be contained in the set of valid values with id: 'MFP-REASON-PARTICIPATION-ENDED' and MFP-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2285	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'MFP-REINSTITUTIONALIZED-REASON''	If the field is populated, the value must be contained in the set of valid values with id: 'MFP-REINSTITUTIONALIZED-REASON' and MFP-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2300	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and STATE-PLAN-OPTION-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-EFF-DATE must be >= Valid Values Effective-Date and STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2307	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE-PLAN-OPTION-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE-PLAN-OPTION-TYPE' and STATE-PLAN-OPTION-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-EFF-DATE must be >= Valid Values Effective-Date and STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2323	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and WAIVER-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2334	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE' and WAIVER-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2348	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and LTSS-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and LTSS-PARTICIPATION.LTSS-ELIGIBILITY-EFF-DATE must be >= Valid Values Effective-Date and LTSS-PARTICIPATION.LTSS-ELIGIBILITY-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2355	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'LTSS-LEVEL-CARE''	If the field is populated, the value must be contained in the set of valid values with id: 'LTSS-LEVEL-CARE' and LTSS-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and LTSS-PARTICIPATION.LTSS-ELIGIBILITY-EFF-DATE must be >= Valid Values Effective-Date and LTSS-PARTICIPATION.LTSS-ELIGIBILITY-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2371	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MANAGED-CARE-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2385	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-PLAN-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-PLAN-TYPE' and MANAGED-CARE-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2388	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE' and MANAGED-CARE-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2402	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and ETHNICITY-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ETHNICITY-INFORMATION.ETHNICITY-DECLARATION-EFF-DATE must be >= Valid Values Effective-Date and ETHNICITY-INFORMATION.ETHNICITY-DECLARATION-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2409	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'ETHNICITY-CODE''	If the field is populated, the value must be contained in the set of valid values with id: 'ETHNICITY-CODE' and ETHNICITY-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ETHNICITY-INFORMATION.ETHNICITY-DECLARATION-EFF-DATE must be >= Valid Values Effective-Date and ETHNICITY-INFORMATION.ETHNICITY-DECLARATION-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2424	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and RACE-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and RACE-INFORMATION.RACE-DECLARATION-EFF-DATE must be >= Valid Values Effective-Date and RACE-INFORMATION.RACE-DECLARATION-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2431	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'RACE''	If the field is populated, the value must be contained in the set of valid values with id: 'RACE' and RACE-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and RACE-INFORMATION.RACE-DECLARATION-EFF-DATE must be >= Valid Values Effective-Date and RACE-INFORMATION.RACE-DECLARATION-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2434	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR''	If the field is populated, the value must be contained in the set of valid values with id: 'CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR' and RACE-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and RACE-INFORMATION.RACE-DECLARATION-EFF-DATE must be >= Valid Values Effective-Date and RACE-INFORMATION.RACE-DECLARATION-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2447	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and DISABILITY-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and DISABILITY-INFORMATION.DISABILITY-TYPE-EFF-DATE must be >= Valid Values Effective-Date and DISABILITY-INFORMATION.DISABILITY-TYPE-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2454	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'DISABILITY-TYPE-CODE''	If the field is populated, the value must be contained in the set of valid values with id: 'DISABILITY-TYPE-CODE' and DISABILITY-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and DISABILITY-INFORMATION.DISABILITY-TYPE-EFF-DATE must be >= Valid Values Effective-Date and DISABILITY-INFORMATION.DISABILITY-TYPE-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2467	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and 1115A-DEMONSTRATION-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and 1115A-DEMONSTRATION-INFORMATION.1115A-EFF-DATE must be >= Valid Values Effective-Date and 1115A-DEMONSTRATION-INFORMATION.1115A-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2474	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND''	If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND' and 1115A-DEMONSTRATION-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and 1115A-DEMONSTRATION-INFORMATION.1115A-EFF-DATE must be >= Valid Values Effective-Date and 1115A-DEMONSTRATION-INFORMATION.1115A-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2488	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME.HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-EFF-DATE must be >= Valid Values Effective-Date and HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME.HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2495	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-CODE''	If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-CODE' and HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME.HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-EFF-DATE must be >= Valid Values Effective-Date and HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME.HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2507	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and ENROLLMENT-TIME-SPAN-SEGMENT.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2514	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'ENROLLMENT-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'ENROLLMENT-TYPE' and ENROLLMENT-TIME-SPAN-SEGMENT.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-7142	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'MARITAL-STATUS''	If the field is populated, the value must be contained in the set of valid values with id: 'MARITAL-STATUS' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-7153	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'MAINTENANCE-ASSISTANCE-STATUS''	If the field is populated, the value must be contained in the set of valid values with id: 'MAINTENANCE-ASSISTANCE-STATUS' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2553	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE has non null value and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2567	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-PROGRAM''	If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-PROGRAM' and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE has non null value and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2568	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-PLAN-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-PLAN-TYPE' and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE has non null value and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2569	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'REIMBURSEMENT-ARRANGEMENT''	If the field is populated, the value must be contained in the set of valid values with id: 'REIMBURSEMENT-ARRANGEMENT' and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE has non null value and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2570	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-PROFIT-STATUS''	If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-PROFIT-STATUS' and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE has non null value and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2571	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'CORE-BASED-STATISTICAL-AREA-CODE''	If the field is populated, the value must be contained in the set of valid values with id: 'CORE-BASED-STATISTICAL-AREA-CODE' and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE has non null value and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2574	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-SERVICE-AREA''	If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-SERVICE-AREA' and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE has non null value and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2586	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2604	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-ADDR-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-ADDR-TYPE' and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2614	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2616	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'COUNTY''	If the field is populated, the value must be contained in the set of valid values with id: 'COUNTY' and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2623	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE has non null value and MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2645	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MANAGED-CARE-OPERATING-AUTHORITY.MANAGED-CARE-OP-AUTHORITY-EFF-DATE has non null value and MANAGED-CARE-OPERATING-AUTHORITY.MANAGED-CARE-OP-AUTHORITY-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-OPERATING-AUTHORITY.MANAGED-CARE-OP-AUTHORITY-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2653	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'OPERATING-AUTHORITY''	If the field is populated, the value must be contained in the set of valid values with id: 'OPERATING-AUTHORITY' and MANAGED-CARE-OPERATING-AUTHORITY.MANAGED-CARE-OP-AUTHORITY-EFF-DATE has non null value and MANAGED-CARE-OPERATING-AUTHORITY.MANAGED-CARE-OP-AUTHORITY-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-OPERATING-AUTHORITY.MANAGED-CARE-OP-AUTHORITY-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2668	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MANAGED-CARE-PLAN-POPULATION-ENROLLED.MANAGED-CARE-PLAN-POP-EFF-DATE has non null value and MANAGED-CARE-PLAN-POPULATION-ENROLLED.MANAGED-CARE-PLAN-POP-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-PLAN-POPULATION-ENROLLED.MANAGED-CARE-PLAN-POP-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2676	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'ELIGIBILITY-GROUP''	If the field is populated, the value must be contained in the set of valid values with id: 'ELIGIBILITY-GROUP' and MANAGED-CARE-PLAN-POPULATION-ENROLLED.MANAGED-CARE-PLAN-POP-EFF-DATE has non null value and MANAGED-CARE-PLAN-POPULATION-ENROLLED.MANAGED-CARE-PLAN-POP-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-PLAN-POPULATION-ENROLLED.MANAGED-CARE-PLAN-POP-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2689	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MANAGED-CARE-ACCREDITATION-ORGANIZATION.DATE-ACCREDITATION-ACHIEVED has non null value and MANAGED-CARE-ACCREDITATION-ORGANIZATION.DATE-ACCREDITATION-ACHIEVED must be >= Valid Values Effective-Date and MANAGED-CARE-ACCREDITATION-ORGANIZATION.DATE-ACCREDITATION-ACHIEVED <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2697	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'ACCREDITATION-ORGANIZATION''	If the field is populated, the value must be contained in the set of valid values with id: 'ACCREDITATION-ORGANIZATION' and MANAGED-CARE-ACCREDITATION-ORGANIZATION.DATE-ACCREDITATION-ACHIEVED has non null value and MANAGED-CARE-ACCREDITATION-ORGANIZATION.DATE-ACCREDITATION-ACHIEVED must be >= Valid Values Effective-Date and MANAGED-CARE-ACCREDITATION-ORGANIZATION.DATE-ACCREDITATION-ACHIEVED <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2710	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE has non null value and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE must be >= Valid Values Effective-Date and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2720	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE' and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE has non null value and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE must be >= Valid Values Effective-Date and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2736	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CHPID-SHPID-RELATIONSHIPS.CHPID-SHPID-RELATIONSHIP-EFF-DATE has non null value and CHPID-SHPID-RELATIONSHIPS.CHPID-SHPID-RELATIONSHIP-EFF-DATE must be >= Valid Values Effective-Date and CHPID-SHPID-RELATIONSHIPS.CHPID-SHPID-RELATIONSHIP-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2785	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE has non null value and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE must be >= Valid Values Effective-Date and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2803	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'FACILITY-GROUP-INDIVIDUAL-CODE''	If the field is populated, the value must be contained in the set of valid values with id: 'FACILITY-GROUP-INDIVIDUAL-CODE' and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE has non null value and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE must be >= Valid Values Effective-Date and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2804	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'TEACHING-IND''	If the field is populated, the value must be contained in the set of valid values with id: 'TEACHING-IND' and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE has non null value and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE must be >= Valid Values Effective-Date and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2812	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'SEX''	If the field is populated, the value must be contained in the set of valid values with id: 'SEX' and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE has non null value and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE must be >= Valid Values Effective-Date and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2815	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'OWNERSHIP-CODE''	If the field is populated, the value must be contained in the set of valid values with id: 'OWNERSHIP-CODE' and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE has non null value and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE must be >= Valid Values Effective-Date and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2816	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'PROV-PROFIT-STATUS''	If the field is populated, the value must be contained in the set of valid values with id: 'PROV-PROFIT-STATUS' and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE has non null value and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE must be >= Valid Values Effective-Date and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2825	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'ACCEPTING-NEW-PATIENTS-IND''	If the field is populated, the value must be contained in the set of valid values with id: 'ACCEPTING-NEW-PATIENTS-IND' and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE has non null value and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE must be >= Valid Values Effective-Date and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2829	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2848	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'PROV-ADDR-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'PROV-ADDR-TYPE' and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2856	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2861	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'ADDR-BORDER-STATE-IND''	If the field is populated, the value must be contained in the set of valid values with id: 'ADDR-BORDER-STATE-IND' and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2863	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'COUNTY''	If the field is populated, the value must be contained in the set of valid values with id: 'COUNTY' and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2868	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-LICENSING-INFO.PROV-LICENSE-EFF-DATE has non null value and PROV-LICENSING-INFO.PROV-LICENSE-EFF-DATE must be >= Valid Values Effective-Date and PROV-LICENSING-INFO.PROV-LICENSE-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2884	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'LICENSE-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'LICENSE-TYPE' and PROV-LICENSING-INFO.PROV-LICENSE-EFF-DATE has non null value and PROV-LICENSING-INFO.PROV-LICENSE-EFF-DATE must be >= Valid Values Effective-Date and PROV-LICENSING-INFO.PROV-LICENSE-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2893	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE has non null value and PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE must be >= Valid Values Effective-Date and PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2900	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'PROV-IDENTIFIER-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'PROV-IDENTIFIER-TYPE' and PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE has non null value and PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE must be >= Valid Values Effective-Date and PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2921	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE has non null value and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE must be >= Valid Values Effective-Date and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2927	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'PROV-CLASSIFICATION-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'PROV-CLASSIFICATION-TYPE' and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE has non null value and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE must be >= Valid Values Effective-Date and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2928	UPDATE	Data Dictionary - Validation Rules	if PROV-TAXONOMY-CLASSIFICATION has a valid, non-null value for PROV-CLASSIFICATION-TYPE and PROV-TAXONOMY-CLASSIFICATION has a valid, non-null value for PROV-CLASSIFICATION-CODE, then if PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-TYPE is '1' then PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-CODE is a valid value in 'PROV-CLASSIFICATION-CODE-TYPE-1' on the date specified by PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE. If PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-TYPE is '2' then PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-CODE is a valid value in 'PROV-SPECIALTY' on the date specified by PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE. If PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-TYPE is '3' then PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-CODE is a valid value in 'PROV-TYPE' on the date specified by PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE. If PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-TYPE is '4' then PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-CODE is a valid value in 'PROV-CLASSIFICATION-CODE-TYPE-4' on the date specified by PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE.'	if PROV-TAXONOMY-CLASSIFICATION has a valid, non-null value for PROV-CLASSIFICATION-TYPE and PROV-TAXONOMY-CLASSIFICATION has a valid, non-null value for PROV-CLASSIFICATION-CODE, then if PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-TYPE is '1' then PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-CODE is a valid value in 'PROV-CLASSIFICATION-CODE-TYPE-1' on the date specified by PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE. If PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-TYPE is '2' then PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-CODE is a valid value in 'PROV-SPECIALTY' on the date specified by PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE. If PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-TYPE is '3' then PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-CODE is a valid value in 'PROV-TYPE' on the date specified by PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE. If PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-TYPE is '4' then PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-CODE is a valid value in 'PROV-CLASSIFICATION-CODE-TYPE-4' on the date specified by PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE.' and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE has non null value and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE must be >= Valid Values Effective-Date and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2941	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE has non null value and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE must be >= Valid Values Effective-Date and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2956	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'PROV-MEDICAID-ENROLLMENT-STATUS-CODE''	If the field is populated, the value must be contained in the set of valid values with id: 'PROV-MEDICAID-ENROLLMENT-STATUS-CODE' and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE has non null value and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE must be >= Valid Values Effective-Date and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2957	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'STATE-PLAN-ENROLLMENT''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE-PLAN-ENROLLMENT' and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE has non null value and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE must be >= Valid Values Effective-Date and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2958	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'PROV-ENROLLMENT-METHOD''	If the field is populated, the value must be contained in the set of valid values with id: 'PROV-ENROLLMENT-METHOD' and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE has non null value and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE must be >= Valid Values Effective-Date and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2964	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-AFFILIATED-GROUPS.PROV-AFFILIATED-GROUP-EFF-DATE has non null value and PROV-AFFILIATED-GROUPS.PROV-AFFILIATED-GROUP-EFF-DATE must be >= Valid Values Effective-Date and PROV-AFFILIATED-GROUPS.PROV-AFFILIATED-GROUP-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2983	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-EFF-DATE has non null value and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-EFF-DATE must be >= Valid Values Effective-Date and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-2989	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'AFFILIATED-PROGRAM-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'AFFILIATED-PROGRAM-TYPE' and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-EFF-DATE has non null value and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-EFF-DATE must be >= Valid Values Effective-Date and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3005	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-BED-TYPE-INFO.BED-TYPE-EFF-DATE has non null value and PROV-BED-TYPE-INFO.BED-TYPE-EFF-DATE must be >= Valid Values Effective-Date and PROV-BED-TYPE-INFO.BED-TYPE-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3022	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'BED-TYPE-CODE''	If the field is populated, the value must be contained in the set of valid values with id: 'BED-TYPE-CODE' and PROV-BED-TYPE-INFO.BED-TYPE-EFF-DATE has non null value and PROV-BED-TYPE-INFO.BED-TYPE-EFF-DATE must be >= Valid Values Effective-Date and PROV-BED-TYPE-INFO.BED-TYPE-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3054	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3062	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'TPL-HEALTH-INSURANCE-COVERAGE-IND''	If the field is populated, the value must be contained in the set of valid values with id: 'TPL-HEALTH-INSURANCE-COVERAGE-IND' and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3063	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'TPL-OTHER-COVERAGE-IND''	If the field is populated, the value must be contained in the set of valid values with id: 'TPL-OTHER-COVERAGE-IND' and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3078	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3091	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'INSURANCE-PLAN-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'INSURANCE-PLAN-TYPE' and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3099	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'POLICY-OWNER-CODE''	If the field is populated, the value must be contained in the set of valid values with id: 'POLICY-OWNER-CODE' and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3115	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3122	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'INSURANCE-PLAN-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'INSURANCE-PLAN-TYPE' and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3123	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'COVERAGE-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'COVERAGE-TYPE' and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3136	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.OTHER-TPL-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.OTHER-TPL-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.OTHER-TPL-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3144	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-OTHER-THIRD-PARTY-LIABILITY''	If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-OTHER-THIRD-PARTY-LIABILITY' and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.OTHER-TPL-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.OTHER-TPL-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.OTHER-TPL-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3157	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE has non null value and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3162	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'TPL-ENTITY-ADDR-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'TPL-ENTITY-ADDR-TYPE' and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE has non null value and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3170	UPDATE	Data Dictionary - Validation Rules	'If the field is populated, the value must be contained in the set of valid values with id: 'STATE''	If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE has non null value and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3182	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'COVERAGE-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'COVERAGE-TYPE' and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE <= Valid Values End-Date
01/31/2020	2.4.0	RULE-3185	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE''	If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE' and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE has non null value and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE <= Valid Values End-Date
06/24/2022	3.0.0	PRV081/ PROV-IDENTIFIER	Modify DE Width	Data Dictionary - Record Layout	SIZE X(12)	SIZE X(30)
06/24/2022	3.0.0	CIP278/ NDC-QUANTITY	Modify DE Width	Data Dictionary - Record Layout	SIZE S9(6)V999	SIZE S9(8)V999
06/24/2022	3.0.0	CLT230/ NDC-QUANTITY	Modify DE Width	Data Dictionary - Record Layout	SIZE S9(6)V999	SIZE S9(8)V999
06/24/2022	3.0.0	COT225/ NDC-QUANTITY	Modify DE Width	Data Dictionary - Record Layout	SIZE S9(6)V999	SIZE S9(8)V999
04/13/2018	2.2.0	RULE-572	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for NON-COV-DAYS and CLAIM-HEADER-RECORD-IP has a valid, non-null value for MEDICAID-COV-INPATIENT-DAYS, then the sum of CLAIM-HEADER-RECORD-IP.NON-COV-DAYS and CLAIM-HEADER-RECORD-IP.MEDICAID-COV-INPATIENT-DAYS is less than or equal to the number of days between the earliest CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE date and the latest CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE date', where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS does not equal '585'	N/A
04/13/2018	2.2.0	RULE-1011	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for NON-COV-DAYS and CLAIM-HEADER-RECORD-LT has a valid, non-null value for MEDICAID-COV-INPATIENT-DAYS and CLAIM-HEADER-RECORD-LT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT has a valid, non-null value for ENDING-DATE-OF-SERVICE, then the sum of CLAIM-HEADER-RECORD-LT.NON-COV-DAYS and CLAIM-HEADER-RECORD-LT.MEDICAID-COV-INPATIENT-DAYS is less than or equal to the number of days between CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE	N/A
06/24/2022	3.0.0	CRX131	Modify DE Width	Data Dictionary - Record Layout	SIZE S9(6)V999	SIZE S9(8)V999
06/24/2022	3.0.0	CRX132	Modify DE Width	Data Dictionary - Record Layout	SIZE S9(6)V999	SIZE S9(8)V999
06/24/2022	3.0.0	COT183	Modify DE Width	Data Dictionary - Record Layout	SIZE S9(6)V999	SIZE S9(8)V999
06/24/2022	3.0.0	COT184	Modify DE Width	Data Dictionary - Record Layout	SIZE S9(6)V999	SIZE S9(8)V999
12/29/2017	2.2.0	RULE-561	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.PROGRAM-TYPE equals '07', then CLAIM-HEADER-RECORD-IP.WAIVER-TYPE is equal to one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20'	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.PROGRAM-TYPE equals '07', then CLAIM-HEADER-RECORD-IP.WAIVER-TYPE is equal to one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20', '33'
12/29/2017	2.2.0	RULE-1419	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.PROGRAM-TYPE equals '07', then CLAIM-HEADER-RECORD-OT.WAIVER-TYPE is equal to one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.PROGRAM-TYPE equals '07', then CLAIM-HEADER-RECORD-OT.WAIVER-TYPE is equal to one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20', '33'
12/29/2017	2.2.0	RULE-1000	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.PROGRAM-TYPE equals '07', then CLAIM-HEADER-RECORD-LT.WAIVER-TYPE is equal to one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20'	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.PROGRAM-TYPE equals '07', then CLAIM-HEADER-RECORD-LT.WAIVER-TYPE is equal to one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20', '33'
03/30/2018	2.2.0	RULE-482	UPDATE	Data Dictionary - Validation Rules	Value not valid for state-supplied format (format or valid values)	Value not in specified valid value set
03/30/2018	2.2.0	RULE-469	UPDATE	Data Dictionary - Validation Rules	Value not valid for state-supplied format (format or valid values)	Value not in specified valid value set
03/30/2018	2.2.0	RULE-455	UPDATE	Data Dictionary - Validation Rules	Value not valid for state-supplied format (format or valid values)	Value not in specified valid value set
03/30/2018	2.2.0	RULE-442	UPDATE	Data Dictionary - Validation Rules	Value not valid for state-supplied format (format or valid values)	Value not in specified valid value set
03/30/2018	2.2.0	RULE-429	UPDATE	Data Dictionary - Validation Rules	Value not valid for state-supplied format (format or valid values)	Value not in specified valid value set
03/30/2018	2.2.0	RULE-416	UPDATE	Data Dictionary - Validation Rules	Value not valid for state-supplied format (format or valid values)	Value not in specified valid value set
03/30/2018	2.2.0	RULE-1718	UPDATE	Data Dictionary - Validation Rules	Value not valid for state-supplied format (format or valid values)	Value not in specified valid value set
03/30/2018	2.2.0	RULE-1706	UPDATE	Data Dictionary - Validation Rules	Value not valid for state-supplied format (format or valid values)	Value not in specified valid value set
03/30/2018	2.2.0	RULE-1703	UPDATE	Data Dictionary - Validation Rules	Value not valid for state-supplied format (format or valid values)	Value not in specified valid value set
03/30/2018	2.2.0	RULE-1642	UPDATE	Data Dictionary - Validation Rules	Value not valid for state-supplied format (format or valid values)	Value not in specified valid value set
05/25/2018	2.2.0	ELG036	UPDATE	Data Dictionary	"For SSN states, the MSIS-IDENTIFICATION-NUM and SSN fields should match and be populated with the eligible person’s social security number."	"For SSN states, the MSIS-IDENTIFICATION-NUM and SSN fields should match and be populated with the eligible person’s social security number. States should submit a 9-digit number for the SSN."
05/25/2018	2.2.0	ELG036	UPDATE	Data Dictionary - Record Layout	SIZE text "9(9)"	SIZE text "X(9)"
02/23/2018	2.2.0	RULE-2863	UPDATE	Data Dictionary - Validation Rules	if PROV-LOCATION-AND-CONTACT-INFO has a valid, non-null value for ADDR-COUNTY, then PROV-LOCATION-AND-CONTACT-INFO has a valid, non-null value for SUBMITTING-STATE and The concatenation of PROV-LOCATION-AND-CONTACT-INFO.SUBMITTING-STATE and PROV-LOCATION-AND-CONTACT-INFO.ADDR-COUNTY must be contained in the set of valid values with id: 'COUNTY'	if PROV-LOCATION-AND-CONTACT-INFO has a valid, non-null value for ADDR-COUNTY, then PROV-LOCATION-AND-CONTACT-INFO has a valid, non-null value for ADDR-STATE and The concatenation of PROV-LOCATION-AND-CONTACT-INFO. ADDR-STATE and PROV-LOCATION-AND-CONTACT-INFO.ADDR-COUNTY must be contained in the set of valid values with id: 'COUNTY'
02/23/2018	2.2.0	RULE-2616	UPDATE	Data Dictionary - Validation Rules	if MANAGED-CARE-LOCATION-AND-CONTACT-INFO has a valid, non-null value for MANAGED-CARE-COUNTY, then MANAGED-CARE-LOCATION-AND-CONTACT-INFO has a valid, non-null value for SUBMITTING-STATE and The concatenation of MANAGED-CARE-LOCATION-AND-CONTACT-INFO.SUBMITTING-STATE and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-COUNTY must be contained in the set of valid values with id: 'COUNTY'	if MANAGED-CARE-LOCATION-AND-CONTACT-INFO has a valid, non-null value for MANAGED-CARE-COUNTY, then MANAGED-CARE-LOCATION-AND-CONTACT-INFO has a valid, non-null value for MANAGED-CARE-STATE and The concatenation of MANAGED-CARE-LOCATION-AND-CONTACT-INFO. MANAGED-CARE-STATE and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-COUNTY must be contained in the set of valid values with id: 'COUNTY'
02/23/2018	2.2.0	RULE-2098	UPDATE	Data Dictionary - Validation Rules	if ELIGIBLE-CONTACT-INFORMATION has a valid, non-null value for ELIGIBLE-COUNTY-CODE, then ELIGIBLE-CONTACT-INFORMATION has a valid, non-null value for SUBMITTING-STATE and The concatenation of ELIGIBLE-CONTACT-INFORMATION.SUBMITTING-STATE and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-COUNTY-CODE must be contained in the set of valid values with id: 'COUNTY''	if ELIGIBLE-CONTACT-INFORMATION has a valid, non-null value for ELIGIBLE-COUNTY-CODE, then ELIGIBLE-CONTACT-INFORMATION has a valid, non-null value for ELIGIBLE-STATE and The concatenation of ELIGIBLE-CONTACT-INFORMATION. ELIGIBLE-STATE and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-COUNTY-CODE must be contained in the set of valid values with id: 'COUNTY'
06/24/2022	3.0.0	DRG-REL-WEIGHT	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CIP195\|DRG Relative Weight \|The relative weight for the DRG on the claim. Each year CMS assigns a relative weight to each DRG. These weights indicate the relative costs for treating patients during the prior year. The national average charge for each DRG is compared to the overall average. This ratio is published annually in the Federal Register for each DRG. A DRG with a weight of 2.0000 means that charges were historically twice the average; a DRG with a weight of 0.5000 was half the average.\|	\|DE No\|Data Element Name\|Definition\| \|CIP195\|DRG Relative Weight\|The relative weight for the DRG on the claim. Each year CMS assigns a relative weight to each DRG. These weights indicate the relative costs for treating patients during the prior year. The national average charge for each DRG is compared to the overall average. This ratio is published annually in the Federal Register for each DRG. A DRG with a weight of 2.0000 means that charges were historically twice the average; a DRG with a weight of 0.5000 was half the average. This data element in T-MSIS is expected to capture the relative weight of the DRG in the state's system regardless of which DRG system the state uses.\|
05/25/2018	2.2.0	RULE-6604	UPDATE	Data Dictionary - Validation Rules	"Value must be compatible with specified T-MSIS picture format: 9(9)"	"Value must be compatible with specified T-MSIS picture format: X(9)"
05/25/2018	2.2.0	RULE-7182	ADD	Data Dictionary - Validation Rules	N/A	if the SSN is populated, the value submitted for.SSN must be a 9-digit number
08/30/2018	2.3.0	RULE-884	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 to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data element should be NOT NULL SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys Date check on CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE
08/30/2018	2.3.0	RULE-335	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 to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data element should be NOT NULL SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-IP.ADMISSION-DATE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE	N/A
08/30/2018	2.3.0	RULE-1758	UPDATE	Data Dictionary - Validation Rules	If (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) OR CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data element should be NOT NULL SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys Date check on Date check on CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE
08/30/2018	2.3.0	RULE-1337	UPDATE	Data Dictionary - Validation Rules	If (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data element should be NOT NULL SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys Date check on CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.END-DATE-OF-SERVICE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE
07/06/2018	2.3.0	RULE-884	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys Date check on CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE	If (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data element should be NOT NULL SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
07/06/2018	2.3.0	RULE-335	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys Date check on CLAIM-HEADER-RECORD-IP.ADMISSION-DATE and CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE	If (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data element should be NOT NULL SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-IP.ADMISSION-DATE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
07/06/2018	2.3.0	RULE-1758	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys Date check on Date check on CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE	If (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) OR CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data element should be NOT NULL SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
07/06/2018	2.3.0	RULE-1337	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys Date check on CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.END-DATE-OF-SERVICE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE	If (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data element should be NOT NULL SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
08/30/2018	2.3.0	RULE-3060	UPDATE	Data Dictionary - Validation Rules	record TPL-MEDICAID-ELIGIBLE-PERSON-MAIN has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY	N/A
07/06/2018	2.3.0	RULE-3060	ADD	Data Dictionary - Validation Rules	N/A	record TPL-MEDICAID-ELIGIBLE-PERSON-MAIN has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY
08/30/2018	2.3.0	RULE-2165	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ELIGIBILITY-DETERMINANT-EFF-DATE. End date field: ELIGIBILITY-DETERMINANT-END-DATE	N/A
07/06/2018	2.3.0	RULE-2165	ADD	Data Dictionary - Validation Rules	N/A	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ELIGIBILITY-DETERMINANT-EFF-DATE. End date field: ELIGIBILITY-DETERMINANT-END-DATE
08/30/2018	2.3.0	RULE-1964	UPDATE	Data Dictionary - Validation Rules	if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-RX has a valid, non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM then for every record of type CLAIM-HEADER-RECORD-RX, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1')	DISPENSING-PRESCRIPTION-DRUG-PROV-NUM (CRX) 'if CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does not equal '585', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1'
01/18/2019	2.3.0	RULE-7186	ADD	Data Dictionary - Validation Rules	N/A	The data elements SUBMITTING_STATE, ICN-ORIG , ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND should be unique across all records of type CLAIM-HEADER-RECORD-RX
01/18/2019	2.3.0	RULE-7185	ADD	Data Dictionary - Validation Rules	N/A	The data elements SUBMITTING_STATE, ICN-ORIG , ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND should be unique across all records of type CLAIM-HEADER-RECORD-OT
01/18/2019	2.3.0	RULE-7184	ADD	Data Dictionary - Validation Rules	N/A	The data elements SUBMITTING_STATE, ICN-ORIG , ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND should be unique across all records of type CLAIM-HEADER-RECORD-LT
01/18/2019	2.3.0	RULE-7183	ADD	Data Dictionary - Validation Rules	N/A	The data elements SUBMITTING_STATE, ICN-ORIG , ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND should be unique across all records of type CLAIM-HEADER-RECORD-IP
02/01/2019	2.3.0	RULE-7190	ADD	Data Dictionary - Validation Rules	N/A	The data elements SUBMITTING-STATE,ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND should be unique across all records of type CLAIM-LINE-RECORD-RX
02/01/2019	2.3.0	RULE-7189	ADD	Data Dictionary - Validation Rules	N/A	The data elements SUBMITTING-STATE,ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND should be unique across all records of type CLAIM-LINE-RECORD-OT
02/01/2019	2.3.0	RULE-7188	ADD	Data Dictionary - Validation Rules	N/A	The data elements SUBMITTING-STATE,ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND should be unique across all records of type CLAIM-LINE-RECORD-LT
02/01/2019	2.3.0	RULE-7187	ADD	Data Dictionary - Validation Rules	N/A	The data elements SUBMITTING-STATE,ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND should be unique across all records of type CLAIM-LINE-RECORD-IP
08/30/2018	2.3.0	RULE-774	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND
08/30/2018	2.3.0	RULE-1916	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: LINE-ADJUSTMENT-IND	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND
08/30/2018	2.3.0	RULE-1616	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: LINE-ADJUSTMENT-IND	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND
08/30/2018	2.3.0	RULE-1211	UPDATE	Data Dictionary - Validation Rules	If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND
07/20/2018	2.3.0	RULE-1916	UPDATE	Data Dictionary - Validation Rules	LINE-ADJUSTMENT-IND (CRX) if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: LINE-ADJUSTMENT-IND	LINE-ADJUSTMENT-IND (CRX) If the field is populated, the value must be contained in the set of valid values with id: LINE-ADJUSTMENT-IND
07/20/2018	2.3.0	RULE-1616	UPDATE	Data Dictionary - Validation Rules	LINE-ADJUSTMENT-IND (COT) if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: LINE-ADJUSTMENT-IND	LINE-ADJUSTMENT-IND (COT) If the field is populated, the value must be contained in the set of valid values with id: LINE-ADJUSTMENT-IND
07/20/2018	2.3.0	RULE-1211	UPDATE	Data Dictionary - Validation Rules	LINE-ADJUSTMENT-IND (CLT) if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND	LINE-ADJUSTMENT-IND (CLT) If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND
08/30/2018	2.3.0	RULE-689	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 to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM then for every record of type CLAIM-HEADER-RECORD-IP, ((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE,CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') AND CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE must in (PROV_IDENTIFIER_EFF_DATE, PROV_IDENTIFIER_END_DATE))) Note: If CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE is NULL Then rule should not trigger.	N/A
08/30/2018	2.3.0	RULE-1845	UPDATE	Data Dictionary - Validation Rules	if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM then for every record of type CLAIM-HEADER-RECORD-RX, ((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))	BILLING-PROV-NUM (CRX) if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1'
08/30/2018	2.3.0	RULE-1540	UPDATE	Data Dictionary - Validation Rules	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NUM then for every record of type CLAIM-HEADER-RECORD-OT, ((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-OT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') AND CLAIM-HEADER-RECORD-OT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))	N/A
08/30/2018	2.3.0	RULE-1126	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 to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") OR CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-LT has a valid, non-null value for BILLING-PROV-NUM then for every record of type CLAIM-HEADER-RECORD-LT, ((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER ), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))	N/A
08/03/2018	2.3.0	RULE-689	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 to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM then for every record of type CLAIM-HEADER-RECORD-IP, ((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE,CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') AND CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE must in (PROV_IDENTIFIER_EFF_DATE, PROV_IDENTIFIER_END_DATE))) Note: If CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE is NULL Then rule should not trigger.
08/03/2018	2.3.0	RULE-1845	UPDATE	Data Dictionary - Validation Rules	BILLING-PROV-NUM (CRX) if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1'	if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM then for every record of type CLAIM-HEADER-RECORD-RX, ((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))
08/03/2018	2.3.0	RULE-1540	ADD	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NUM then for every record of type CLAIM-HEADER-RECORD-OT, ((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-OT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') AND CLAIM-HEADER-RECORD-OT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))
08/03/2018	2.3.0	RULE-1126	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 to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") OR CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-LT has a valid, non-null value for BILLING-PROV-NUM then for every record of type CLAIM-HEADER-RECORD-LT, ((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER ), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))
08/30/2018	2.3.0	RULE-810	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 to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NUM then for every record of type CLAIM-LINE-RECORD-IP, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1')	N/A
08/30/2018	2.3.0	RULE-1663	UPDATE	Data Dictionary - Validation Rules	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM then for every record of type CLAIM-LINE-RECORD-OT, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys () OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1')	N/A
08/30/2018	2.3.0	RULE-1246	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 to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-LT has a valid, non-null value for SERVICING-PROV-NUM then for every record of type CLAIM-LINE-RECORD-LT, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1')	SERVICING-PROV-NUM (CLT) 'if CLAIM-HEADER-RECORD-LT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1'
08/17/2018	2.3.0	RULE-810	UPDATE	Data Dictionary - Validation Rules	SERVICING-PROV-NUM (CIP) 'if CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NUM and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS does not equal '585', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1'	if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NUM then for every record of type CLAIM-LINE-RECORD-IP, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1')
08/17/2018	2.3.0	RULE-1964	UPDATE	Data Dictionary - Validation Rules	DISPENSING-PRESCRIPTION-DRUG-PROV-NUM (CRX) 'if CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does not equal '585', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1'	if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-RX has a valid, non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM then for every record of type CLAIM-HEADER-RECORD-RX, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1')
08/17/2018	2.3.0	RULE-1663	UPDATE	Data Dictionary - Validation Rules	SERVICING-PROV-NUM (COT) 'if CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does not equal '585', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1'	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM then for every record of type CLAIM-LINE-RECORD-OT, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys () OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1')
08/17/2018	2.3.0	RULE-1246	UPDATE	Data Dictionary - Validation Rules	SERVICING-PROV-NUM (CLT) 'if CLAIM-HEADER-RECORD-LT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1'	if (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-LT has a valid, non-null value for SERVICING-PROV-NUM then for every record of type CLAIM-LINE-RECORD-LT, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1')
08/30/2018	2.3.0	RULE-564	UPDATE	Data Dictionary - Validation Rules	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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM	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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM
08/30/2018	2.3.0	RULE-1819	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM
08/30/2018	2.3.0	RULE-1004	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM
08/03/2018	2.3.0	RULE-564	UPDATE	Data Dictionary - Validation Rules	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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM	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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM
08/03/2018	2.3.0	RULE-1819	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM
08/03/2018	2.3.0	RULE-1004	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM
08/30/2018	2.3.0	RULE-7192	UPDATE	Data Dictionary - Validation Rules	IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "2" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be equal to "3" For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE <= ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data elements should be NOT NULL VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE	N/A
08/30/2018	2.3.0	RULE-7191	UPDATE	Data Dictionary - Validation Rules	IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "1" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be in ("1","2") For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE <= ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data elements should be NOT NULL VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE	N/A
08/17/2018	2.3.0	RULE-7192	ADD	Data Dictionary - Validation Rules	N/A	IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "2" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be equal to "3" For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE <= ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data elements should be NOT NULL VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
08/17/2018	2.3.0	RULE-7191	ADD	Data Dictionary - Validation Rules	N/A	IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "1" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be in ("1","2") For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE <= ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data elements should be NOT NULL VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
08/30/2018	2.3.0	RULE-7197	UPDATE	Data Dictionary - Validation Rules	if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER has non null value then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE, CLAIM-HEADER-RECORD-RX.MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail	N/A
08/30/2018	2.3.0	RULE-7196	UPDATE	Data Dictionary - Validation Rules	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER has non null value then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-OT. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-OT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail	N/A
08/30/2018	2.3.0	RULE-7195	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 to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER has non null value then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-LT. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-LT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail	N/A
08/30/2018	2.3.0	RULE-7194	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 to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER has non null value then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE, CLAIM-HEADER-RECORD-IP. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail	N/A
08/17/2018	2.3.0	RULE-7197	ADD	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER has non null value then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE, CLAIM-HEADER-RECORD-RX.MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail
08/17/2018	2.3.0	RULE-7196	ADD	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER has non null value then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-OT. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-OT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail
08/17/2018	2.3.0	RULE-7195	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 to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER has non null value then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-LT. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-LT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail
08/17/2018	2.3.0	RULE-7194	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 to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER has non null value then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE, CLAIM-HEADER-RECORD-IP. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail
08/30/2018	2.3.0	RULE-7201	UPDATE	Data Dictionary - Validation Rules	if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER has non null value then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE, CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail	N/A
08/30/2018	2.3.0	RULE-7200	UPDATE	Data Dictionary - Validation Rules	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER has non null value then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-OT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail	N/A
08/30/2018	2.3.0	RULE-7199	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 to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER has non null value then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-LT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail	N/A
08/30/2018	2.3.0	RULE-7198	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 to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER has non null value then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-MAIN-MCR00002 that matches on the join keys (CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE, CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail	N/A
08/17/2018	2.3.0	RULE-7201	ADD	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER has non null value then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE, CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail
08/17/2018	2.3.0	RULE-7200	ADD	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER has non null value then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-OT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail
08/17/2018	2.3.0	RULE-7199	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 to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER has non null value then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-LT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail
08/17/2018	2.3.0	RULE-7198	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 to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER has non null value then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-MAIN-MCR00002 that matches on the join keys (CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE, CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail
11/23/2018	2.3.0	RULE-774	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND	If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'. Note: With this deployment, these are the valid values for LINE-ADJUSTMENT-IND: 0 – Original 1 – Void 4 – Debit Adjustment 5 –Credit Gross Adjustment 6 - Debit Gross Adjustment The following valid values were removed from LINE-ADJUSTMENT-IND in Data Dictionary version 2.1 published November 2017. States should no longer report these valid values for (LINE-)ADJUSTMENT-IND. 2 - Resubmittal 3 – Credit Adjustment
11/23/2018	2.3.0	RULE-564	UPDATE	Data Dictionary - Validation Rules	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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM	'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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM'
11/23/2018	2.3.0	RULE-2165	UPDATE	Data Dictionary - Validation Rules	N/A	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges (ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANT-END-DATE).
11/23/2018	2.3.0	RULE-1916	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND	If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'. Note: With this deployment, these are the valid values for LINE-ADJUSTMENT-IND: 0 – Original 1 – Void 4 – Debit Adjustment 5 –Credit Gross Adjustment 6 - Debit Gross Adjustment The following valid values were removed from LINE-ADJUSTMENT-IND in Data Dictionary version 2.1 published November 2017. States should no longer report these valid values for (LINE-)ADJUSTMENT-IND. 2 - Resubmittal 3 – Credit Adjustment
11/23/2018	2.3.0	RULE-1819	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM	'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM'
11/23/2018	2.3.0	RULE-1616	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND	If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'. Note: With this deployment, these are the valid values for LINE-ADJUSTMENT-IND: 0 – Original 1 – Void 4 – Debit Adjustment 5 –Credit Gross Adjustment 6 - Debit Gross Adjustment The following valid values were removed from LINE-ADJUSTMENT-IND in Data Dictionary version 2.1 published November 2017. States should no longer report these valid values for (LINE-)ADJUSTMENT-IND. 2 - Resubmittal 3 – Credit Adjustment
11/23/2018	2.3.0	RULE-1211	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND	If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'. Note: With this deployment, these are the valid values for LINE-ADJUSTMENT-IND: 0 – Original 1 – Void 4 – Debit Adjustment 5 –Credit Gross Adjustment 6 - Debit Gross Adjustment The following valid values were removed from LINE-ADJUSTMENT-IND in Data Dictionary version 2.1 published November 2017. States should no longer report these valid values for (LINE-)ADJUSTMENT-IND. 2 - Resubmittal 3 – Credit Adjustment
11/23/2018	2.3.0	RULE-1004	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-LT has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM'
11/23/2018	2.3.0	RULE-7201	UPDATE	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER has non null value; then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE, CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE
11/23/2018	2.3.0	RULE-7200	UPDATE	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER has non null value; then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-OT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE
11/23/2018	2.3.0	RULE-7199	UPDATE	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 to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER has non null value; then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-LT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE
11/23/2018	2.3.0	RULE-7198	UPDATE	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 to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER has non null value; then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-MAIN-MCR00002 that matches on the join keys (CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE, CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE
11/23/2018	2.3.0	RULE-7197	UPDATE	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER has non null value; then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE, CLAIM-HEADER-RECORD-RX.MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE
11/23/2018	2.3.0	RULE-7196	UPDATE	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER has non null value; then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-OT. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-OT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE
11/23/2018	2.3.0	RULE-7195	UPDATE	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 to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER has non null value; then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-LT. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-LT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE
11/23/2018	2.3.0	RULE-7194	UPDATE	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 to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER has non null value; then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE, CLAIM-HEADER-RECORD-IP. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE
11/23/2018	2.3.0	RULE-7192	UPDATE	Data Dictionary - Validation Rules	N/A	IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "2" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be equal to "3". For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE <= ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data elements should be NOT NULL VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
11/23/2018	2.3.0	RULE-7191	UPDATE	Data Dictionary - Validation Rules	N/A	IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "1" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be in ("1","2"). For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE <= ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data elements should be NOT NULL VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
12/21/2018	2.3.0	RULE-884	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys Date check on CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE	if (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data element should be NOT NULL SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
12/21/2018	2.3.0	RULE-335	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys Date check on CLAIM-HEADER-RECORD-IP.ADMISSION-DATE and CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE	if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data element should be NOT NULL SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-IP.ADMISSION-DATE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
12/21/2018	2.3.0	RULE-3060	UPDATE	Data Dictionary - Validation Rules	record TPL-MEDICAID-ELIGIBLE-PERSON-MAIN has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY	N/A
12/21/2018	2.3.0	RULE-1758	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys Date check on Date check on CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) OR CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data element should be NOT NULL SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
12/21/2018	2.3.0	RULE-1337	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys Date check on CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.END-DATE-OF-SERVICE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE Note: The following data element should be NOT NULL SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
12/21/2018	2.3.0	RULE-810	UPDATE	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 to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NUM then for every record of type CLAIM-LINE-RECORD-IP, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1')
12/21/2018	2.3.0	RULE-689	UPDATE	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 to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM then for every record of type CLAIM-HEADER-RECORD-IP, ((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE,CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') AND CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE must in (PROV_IDENTIFIER_EFF_DATE, PROV_IDENTIFIER_END_DATE))) Note: If CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE is NULL Then rule should not trigger.
12/21/2018	2.3.0	RULE-1964	UPDATE	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-RX has a valid, non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM then for every record of type CLAIM-HEADER-RECORD-RX, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1')
12/21/2018	2.3.0	RULE-1845	UPDATE	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM then for every record of type CLAIM-HEADER-RECORD-RX, ((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))
12/21/2018	2.3.0	RULE-1663	UPDATE	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM then for every record of type CLAIM-LINE-RECORD-OT, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys () OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1')
12/21/2018	2.3.0	RULE-1540	UPDATE	Data Dictionary - Validation Rules	N/A	if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NUM then for every record of type CLAIM-HEADER-RECORD-OT, ((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-OT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') AND CLAIM-HEADER-RECORD-OT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))
12/21/2018	2.3.0	RULE-1246	UPDATE	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 to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-LT has a valid, non-null value for SERVICING-PROV-NUM then for every record of type CLAIM-LINE-RECORD-LT, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1')
12/21/2018	2.3.0	RULE-1126	UPDATE	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 to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") OR CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-LT has a valid, non-null value for BILLING-PROV-NUM then for every record of type CLAIM-HEADER-RECORD-LT, ((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER ), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)))
02/22/2019	2.3.0	RULE-487	UPDATE	Data Dictionary - Validation Rules	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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-6 and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-6 is less than or equal to CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE	N/A
02/22/2019	2.3.0	RULE-475	UPDATE	Data Dictionary - Validation Rules	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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-5 and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-5 is less than or equal to CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE	N/A
02/22/2019	2.3.0	RULE-462	UPDATE	Data Dictionary - Validation Rules	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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-4 and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-4 is less than or equal to CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE	N/A
02/22/2019	2.3.0	RULE-448	UPDATE	Data Dictionary - Validation Rules	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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-3 and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-3 is less than or equal to CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE	N/A
02/22/2019	2.3.0	RULE-435	UPDATE	Data Dictionary - Validation Rules	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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-2 and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-2 is less than or equal to CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE	N/A
02/22/2019	2.3.0	RULE-422	UPDATE	Data Dictionary - Validation Rules	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' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-1 and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-1 is less than or equal to CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE'	N/A
12/04/2020	2.4.0	COT172-0001	UPDATE	Data Dictionary	diagnosis code fields should be left blank (i.e., submitted as "pipe pipe" with nothing in between (\|\|) on PSV files and space-filled on FLF files	All UNUSED PROCEDURE-CODE-MOD or PROCEDURE-CODE-MOD-1 through PROCEDURE-CODE-MOD-4 fields should be left blank (i.e., submitted as "pipe pipe" with nothing in between (\|\|) on PSV files and space-filled on FLF files
12/04/2020	2.4.0	COT218-0004	UPDATE	Data Dictionary	If no corresponding procedure (PROCDURE-CODE-2 through PROCDURE-CODE-6) was performed, leave blank or space-fill.	If no corresponding procedure (PROCDURE-CODE-2 through PROCDURE-CODE-4) was performed, leave blank or space-fill.
12/04/2020	2.4.0	COT219-0004	UPDATE	Data Dictionary	If no corresponding procedure (PROCDURE-CODE-2 through PROCDURE-CODE-6) was performed, leave blank or space-fill.	If no corresponding procedure (PROCDURE-CODE-2 through PROCDURE-CODE-4) was performed, leave blank or space-fill.
12/04/2020	2.4.0	COT227-0001	UPDATE	Data Dictionary	If no corresponding procedure (PROCDURE-CODE-2 through PROCDURE-CODE-6) was performed, leave blank or space-fill.	If no corresponding procedure (PROCDURE-CODE-2 through PROCDURE-CODE-4) was performed, leave blank or space-fill.
01/18/2019	2.3.0	RULE-1423	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-OT.BILLING-PROV-NUM	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-OT.BILLING-PROV-NUM
03/01/2019	2.3.0	RULE-1390	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X', then CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT equals '0.00'	N/A
04/12/2019	2.3.0	RULE-7203	ADD	Data Dictionary - Validation Rules	N/A	'If CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') then If the field is populated and 5th and 6th character value is not null, then 5th and 6th character value must be contained in the set of valid values with id: 'DRUG-UTILIZATION-CODE-E6''
04/12/2019	2.3.0	RULE-7202	ADD	Data Dictionary - Validation Rules	N/A	'If CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') then If the field is populated and 3rd and 4th character value is not null, then 3rd and 4th character value must be contained in the set of valid values with id: 'DRUG-UTILIZATION-CODE-E5''
04/12/2019	2.3.0	RULE-1948	ADD	Data Dictionary - Validation Rules	N/A	If CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') then If the field is populated and 1st and 2nd character value is not null, then 1st and 2nd character value must be contained in the set of valid values with id: 'DRUG-UTILIZATION-CODE-E4''
03/15/2019	2.3.0	RULE-824	UPDATE	Data Dictionary - Validation Rules	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' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '0', '1', '2', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'	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.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'
03/15/2019	2.3.0	RULE-1955	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '0', '1', '2', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'	If CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'
03/15/2019	2.3.0	RULE-1691	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '0', '1', '2', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'
03/15/2019	2.3.0	RULE-1256	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '0', '1', '2', then CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'	If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'
04/19/2019	2.3.0	RULE-2165	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ELIGIBILITY-DETERMINANT-EFF-DATE. End date field: ELIGIBILITY-DETERMINANT-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges (ELIGIBILITY-DETERMINANT.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE and ELIGIBILITY-DETERMINANT.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE).
04/19/2019	2.3.0	RULE-2105	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ELIGIBLE-ADDR-EFF-DATE. End date field: ELIGIBLE-ADDR-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ELIGIBLE-CONTACT-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: ELIGIBLE-CONTACT-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2071	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE. End date field: VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: VARIABLE-DEMOGRAPHIC-ELIGIBILITY.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: VARIABLE-DEMOGRAPHIC-ELIGIBILITY.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2028	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE. End date field: PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PRIMARY-DEMOGRAPHICS-ELIGIBILITY.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PRIMARY-DEMOGRAPHICS-ELIGIBILITY.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2263	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: LOCKIN-EFF-DATE. End date field: LOCKIN-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: LOCK-IN-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: LOCK-IN-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2241	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: HEALTH-HOME-CHRONIC-CONDITION-EFF-DATE. End date field: HEALTH-HOME-CHRONIC-CONDITION-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: HEALTH-HOME-CHRONIC-CONDITIONS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: HEALTH-HOME-CHRONIC-CONDITIONS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2217	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: HEALTH-HOME-SPA-PROVIDER-EFF-DATE. End date field: HEALTH-HOME-SPA-PROVIDER-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: HEALTH-HOME-SPA-PROVIDER.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: HEALTH-HOME-SPA-PROVIDER.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2188	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: HEALTH-HOME-SPA-PARTICIPATION-EFF-DATE. End date field: HEALTH-HOME-SPA-PARTICIPATION-END-DATE,	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: HEALTH-HOME-SPA-PARTICIPATION-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: HEALTH-HOME-SPA-PARTICIPATION-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2361	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: LTSS-ELIGIBILITY-EFF-DATE. End date field: LTSS-ELIGIBILITY-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: LTSS-PARTICIPATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: LTSS-PARTICIPATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2338	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: WAIVER-ENROLLMENT-EFF-DATE. End date field: WAIVER-ENROLLMENT-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: WAIVER-PARTICIPATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: WAIVER-PARTICIPATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2313	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: STATE-PLAN-OPTION-EFF-DATE. End date field: STATE-PLAN-OPTION-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: STATE-PLAN-OPTION-PARTICIPATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: STATE-PLAN-OPTION-PARTICIPATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2289	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MFP-ENROLLMENT-EFF-DATE. End date field: MFP-ENROLLMENT-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MFP-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: MFP-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2458	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: DISABILITY-TYPE-EFF-DATE. End date field: DISABILITY-TYPE-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: DISABILITY-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: DISABILITY-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2438	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: RACE-DECLARATION-EFF-DATE. End date field: RACE-DECLARATION-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: RACE-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: RACE-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2413	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ETHNICITY-DECLARATION-EFF-DATE. End date field: ETHNICITY-DECLARATION-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ETHNICITY-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: ETHNICITY-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2392	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE. End date field: MANAGED-CARE-PLAN-ENROLLMENT-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-PARTICIPATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: MANAGED-CARE-PARTICIPATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2519	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ENROLLMENT-EFF-DATE. End date field: ENROLLMENT-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ENROLLMENT-TIME-SPAN-SEGMENT.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: ENROLLMENT-TIME-SPAN-SEGMENT.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2498	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-EFF-DATE. End date field: HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2478	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: 1115A-EFF-DATE. End date field: 1115A-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: 1115A-DEMONSTRATION-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: 1115A-DEMONSTRATION-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/12/2019	2.3.0	RULE-2950	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-MEDICAID-EFF-DATE. End date field: PROV-MEDICAID-END-DATE	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-MEDICAID-ENROLLMENT.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-MEDICAID-ENROLLMENT.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2911	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-IDENTIFIER-EFF-DATE. End date field: PROV-IDENTIFIER-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-IDENTIFIERS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-IDENTIFIERS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2878	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-LICENSE-EFF-DATE. End date field: PROV-LICENSE-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-LICENSE-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-LICENSE-INFOR.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2841	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE. End date field: PROV-LOCATION-AND-CONTACT-INFO-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-LOCATION-AND-CONTACT-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-LOCATION-AND-CONTACT-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2793	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-ATTRIBUTES-EFF-DATE. End date field: PROV-ATTRIBUTES-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-ATTRIBUTES-MAIN.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-ATTRIBUTES-MAIN.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-3016	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: BED-TYPE-EFF-DATE. End date field: BED-TYPE-END-DATE	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-BED-TYPE-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-BED-TYPE-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2996	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-AFFILIATED-PROGRAM-EFF-DATE. End date field: PROV-AFFILIATED-PROGRAM-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-AFFILIATED-PROGRAMS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-AFFILIATED-PROGRAMS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2974	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-AFFILIATED-GROUP-EFF-DATE. End date field: PROV-AFFILIATED-GROUP-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-AFFILIATED-GROUPS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-AFFILIATED-GROUPS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2950	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-MEDICAID-EFF-DATE. End date field: PROV-MEDICAID-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-MEDICAID-ENROLLMENT.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-MEDICAID-ENROLLMENT.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2932	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-TAXONOMY-CLASSIFICATION-EFF-DATE. End date field: PROV-TAXONOMY-CLASSIFICATION-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-TAXONOMY-CLASSIFICATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-TAXONOMY-CLASSIFICATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2659	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-OP-AUTHORITY-EFF-DATE. End date field: MANAGED-CARE-OP-AUTHORITY-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-OPERATING-AUTHORITY.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: MANAGED-CARE-OPERATING-AUTHORITY.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2636	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-SERVICE-AREA-EFF-DATE. End date field: MANAGED-CARE-SERVICE-AREA-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-SERVICE-AREA.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: MANAGED-CARE-SERVICE-AREA.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2598	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE. End date field: MANAGED-CARE-LOCATION-AND-CONTACT-INFO-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-LOCATION-AND-CONTACT-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: MANAGED-CARE-LOCATION-AND-CONTACT-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2578	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-MAIN-REC-EFF-DATE. End date field: MANAGED-CARE-MAIN-REC-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-MAIN.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: MANAGED-CARE-MAIN.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2750	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: CHPID-SHPID-RELATIONSHIP-EFF-DATE. End date field: CHPID-SHPID-RELATIONSHIP-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: CHPID-SHPID-RELATIONSHIPS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: CHPID-SHPID-RELATIONSHIPS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2726	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE. End date field: NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: NATIONAL-HEALTH-CARE-ENTITY-ID.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2701	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: DATE-ACCREDITATION-ACHIEVED. End date field: DATE-ACCREDITATION-END.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-ACCREDITATION-ORGANIZATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: MANAGED-CARE-ACCREDITATION-ORGANIZATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-2680	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-PLAN-POP-EFF-DATE. End date field: MANAGED-CARE-PLAN-POP-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-PLAN-POPULATION-ENROLLED.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: MANAGED-CARE-PLAN-POPULATION-ENROLLED.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-3127	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: INSURANCE-CATEGORIES-EFF-DATE. End date field: INSURANCE-CATEGORIES-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-3103	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: INSURANCE-COVERAGE-EFF-DATE. End date field: INSURANCE-COVERAGE-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-3070	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ELIG-PRSN-MAIN-EFF-DATE. End date field: ELIG-PRSN-MAIN-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-3176	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: TPL-ENTITY-CONTACT-INFO-EFF-DATE. End date field: TPL-ENTITY-CONTACT-INFO-END-DATE.,	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: TPL-ENTITY-CONTACT-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: TPL-ENTITY-CONTACT-INFORMATIONTPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
04/19/2019	2.3.0	RULE-3148	UPDATE	Data Dictionary - Validation Rules	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: OTHER-TPL-EFF-DATE. End date field: OTHER-TPL-END-DATE.	Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE.
06/19/2020	2.4.0	TYPE-OF-SERVICE (COT186)	ADD	Data Dictionary - Valid Values	N/A	\|Data Element\|Code\|Description\|Effective Date\|End Date\| \|TYPE-OF-SERVICE\|138\|Per member per month (PMPM) payments for health home services\|01/01/0001\|12/31/9999\| \|TYPE-OF-SERVICE\|139\|Per member per month (PMPM) payments for Medicare Part A premiums\|01/01/0001\|12/31/9999 \|TYPE-OF-SERVICE\|140\|Per member per month (PMPM) payments for Medicare Part B premiums\|01/01/0001\|12/31/9999\| \|TYPE-OF-SERVICE\|141\|Per member per month (PMPM) payments for Medicare Advantage Dual Special Needs Plans (D-SNP) – Medicare Part C.\|01/01/0001\|12/31/9999\| \|TYPE-OF-SERVICE\|142\|Per member per month (PMPM) payments for Medicare Part D premiums\|01/01/0001\|12/31/9999\| \|TYPE-OF-SERVICE\|143\|Per member per month (PMPM) payments for other payments\|01/01/0001\|12/31/9999\| \|TYPE-OF-SERVICE\|144\|Payments to individuals for personal assistance services under 1915(j)\|01/01/0001\|12/31/9999\|
05/10/2019	2.3.0	RULE-7207	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.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1' then CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'
05/10/2019	2.3.0	RULE-7206	ADD	Data Dictionary - Validation Rules	N/A	'If CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1' then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'
05/10/2019	2.3.0	RULE-7205	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.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1' then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'
05/10/2019	2.3.0	RULE-7204	ADD	Data Dictionary - Validation Rules	N/A	'If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1' then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'

T-MSIS Data Guide

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FILE SEGMENT LAYOUTS

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