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TMSIS Dataguide Medicaid.gov
Version 3.36.0

RULE-1141

Validation Rule
Last updated

Tier 1.1
Tier Description Value Error
Error Category E1103
Error Category Message Value not in specified valid value set
Rule Type Valid Value
File Segment Number CLT00002
Data Element Name CLAIM-HEADER-RECORD-LT.PATIENT-STATUS
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the PATIENT-STATUS field is populated, the value must be contained in the set of valid values with id: 'PATIENT-STATUS' 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)'
Rule Definition If the patient status is populated on a non-denied claim from an LT file, then the patient status reported must be found in the list of valid values.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-LT.PATIENT-STATUS equal to a valid, non-null value