RULE-7382
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If a claim is a non-denied, non-void claim from an IP file, and is a Medicaid/Medicaid-expansion CHIP or S-CHIP service tracking claim and is an original claim or a replacement/resubmission claim payment then the claim admission date must be populated.
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RULE-7981
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If a claim in a non-denied, original or adjustment FFS crossover claim from an IP file, and the MSIS ID is populated and the admission date is populated with a date that overlaps with the reported eligibility determinant effective and end dates, and the primary eligibility group indicator is equal to '1', then the dual eligible code is equal to '01', '02', '04', '08'
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RULE-7744
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If a claim in a non-denied, original or adjustment Encounter crossover claimfrom an IP file, and the MSIS ID is populated and the admission date is populated with a date that overlaps with the reported eligibility determinant effective and end dates, and the primary eligibility group indicator is equal to '1', then the dual eligible code is equal to '01','02', '04', '08'
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RULE-7806
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If a claim is a non-denied claim and is an original claim or a replacement/resubmission claim payment from an IP file, and is a Medicaid or Medicaid-expansion CHIP Fee for Service or Separate CHIP Fee for Service claim, then the claim header admission date value must be populated.
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RULE-841
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If admission date is populated on a non-denied claim from an IP file that is not a Medicaid or Medicaid-expansion, S-CHIP, or Other Capitated Payment and adjudication date is populated on a non-denied claim line that is not a capitated payment or premium payment, then the admission date value reported must be before or equal to the adjudication date value reported.
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RULE-7770
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If a claim is a non-denied claim from an IP file, and the waiver type is populated, and the claim admission date is between the waiver enrollment effective and end dates, then the claim waiver type is equal to the waiver participation waiver type.
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RULE-7715
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If a claim is a non-denied claim and is an original claim or a replacement/resubmission claim payment from an IP file, and is a Medicaid or Medicaid-expansion CHIP Encounter, or separate CHIP Encounter claim, then the claim header admission date value must be populated.
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RULE-7550
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If the 1115A demonstration indicator is equal to 1 (yes) on a non-denied claim from an IP file, and the admission date is within the 1115A effective and end dates, then the 1115A demonstration indicator value reported on the 1115A demonstration information segment must be populated with a 1 value.
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RULE-7412
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If a claim in a non-denied, original or adjustment FFS or Encounter crossover claim from an IP file, and the MSIS ID is populated and the admission date is populated with a date that overlaps with the reported eligibility determinant effective and end dates, and the primary eligibility group indicator is equal to '1', then the dual eligible code is equal to '01','02', '04', '08'
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RULE-491
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If a claim is a non-denied claim from an IP file, then the admission date value reported must be a valid date of the form CCYYMMDD.
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RULE-7208
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If a claim is a non-denied claim and is an original claim or a replacement/resubmission claim payment from an IP file, and is a Medicaid or Medicaid-expansion CHIP FFS, Medicaid or Medicaid-expansion CHIP Encounter, separate CHIP FFS or separate CHIP Encounter claim, then the admission date value must be populated.
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RULE-7198
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If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other encounter from an IP file, then the plan ID must be equal to the plan ID on a managed care main segment from an MCR file where the admission date on the claim is within the contract effective and end dates of the managed care main segment.
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RULE-7194
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If plan ID is populated on a non-denied, non-void Medicaid, S-CHIP, or Other encounter from an IP file, then the plan ID must be equal to the plan ID on a managed care participation segment from an ELG file with the same MSIS ID and where the admission date on the claim is within the effective and end dates of the managed care participation segment.
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RULE-575
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If Medicaid covered inpatient days, admission date, and discharge date are populated on a non-denied claim from an IP file, then the Medicaid covered inpatient days value reported must be less than or equal to double the number of days between admission date reported and discharge date reported, plus one day.
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RULE-495
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If a non-denied IP claim has a value populated for admission date, and the primary demographics eligibility segment has a value populated for date of death, then the claim admission date is less than or equal to date of death.
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RULE-494
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If discharge date and admission date are populated on a non-denied claim from an IP file, then the admission date value reported must be before or equal to the discharge date value reported.
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RULE-493
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If the admission date and adjudication date are populated on a non-denied, beneficiary-specific Medicaid or S-CHIP claim from an IP file, then the admission date value reported must be before the adjudication date value reported.
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