RULE-1959
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If the XXI MBESCBES category of service is populated on a non-denied claim from an RX file, then the XXI MBESCBES category of service value reported must be in the list of valid values.
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RULE-7038
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If a claim line is a non-denied claim line from an RX file, then the XXI MBESCBES category of service value reported must be compatible with specified T-MSIS picture format: X(3).
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RULE-7379
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If a claim is a non-denied, non-void separate CHIP fee for service or supplemental claim from an RX file, and the total medicaid paid amount is a non-null value and the total medicaid paid amount is not equal to '0.00' and cms 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES-CATEGORY-OF-SERVICE must be populated.
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RULE-7391
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If a claim is a non-denied, non-denied Medicaid/Medicaid-expansion CHIP or separate CHIP service tracking claim from an RX file, and the service tracking payment amount is a non-null value and cms 64 category for federal reimbursement is equal to '02', then the claim line must have a value populated for XXI MBESCBES category of service.
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RULE-7536
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If a claim is a non-denied, non-void Medicaid fee for service, Medicaid CHIP supplemental, Separate CHIP fee for service or Separate CHIP supplemental claim from an RX file, and the total medicaid paid amount is a non-null value and does not equal zero and claim line XIX-MBESCBES category of service is populated, then claim line XXI-MBESCBES category of service has a null value.
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RULE-7640
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If a claim is a non-denied, non-void Medicaid fee for service or Medicaid CHIP supplemental claim from an RX file, and the total medicaid paid amount is a non-null value and non-zero, and cms 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES category of service must be populated.
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RULE-7960
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If a claim is a non-denied, Medicaid or M-CHIP supplemental or Separate CHIP supplemental claim from an RX file, and the total medicaid paid amount is a non-null value and does not equal zero and claim line XIX-MBESCBES category of service is populated, then claim line XXI-MBESCBES category of service must not be populated.
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RULE-7968
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If a claim is a non-denied, separate CHIP supplemental claim from an RX file, and the total medicaid paid amount is a non-null value and the total medicaid paid amount is not equal to 0.00 and cms 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES-CATEGORY-OF-SERVICE must be populated.
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RULE-7972
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If a claim is a non-denied, non-void Medicaid or M-CHIP supplemental claim from an RX file, and the total medicaid paid amount is a non-null value and greater than zero, and CMS 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES category of service must be populated.
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RULE-7940
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If a claim is a non-denied, Medicaid or Medicaid M-CHIP fee for service or Separate CHIP fee for service claim from an RX file, and the total medicaid paid amount is a non-null value and does not equal zero and claim line XIX-MBESCBES category of service is populated, then claim line XXI-MBESCBES category of service must not be populated.
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RULE-7952
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If a claim is a non-denied, separate CHIP fee for service claim from an RX file, and the total medicaid paid amount is a non-null value and the total medicaid paid amount is not equal to zero and CMS 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES-CATEGORY-OF-SERVICE must be populated.
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RULE-7956
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If a claim is a non-denied, non-void Medicaid or M-CHIP fee for service claim from an RX file, and the total medicaid paid amount is a non-null value and greater than zero, and CMS 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES category of service must be populated.
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