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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-1011

Validation Rule
Last updated

Tier 2.0
Tier Description Relational error
Error Category E2001
Error Category Message Values inconsistently specified (single record type, single record)
Rule Type One Record Type (Single Record)
File Segment Number CLT00002
Data Element Name CLAIM-HEADER-RECORD-LT.NON-COV-DAYS • CLAIM-HEADER-RECORD-LT.MEDICAID-COV-INPATIENT-DAYS • CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE • CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE
Validation Logic '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'
Rule Definition If a non-denied LT claim has a value populated for non covered days, medicaid covered inpatient days and a value populated for beginning date of service and ending date of service, then the sum of the covered days of service is less than or equal to the number of days between the claim beginning and end dates of service, plus one day.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-LT.NON-COV-DAYS equal to a valid, non-null value and with CLAIM-HEADER-RECORD-LT.MEDICAID-COV-INPATIENT-DAYS equal to a valid, non-null value and with CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE equal to a valid, non-null value and with CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE equal to a valid, non-null value