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TMSIS Dataguide Medicaid.gov
Version 3.30.0

RULE-1151

Validation Rule
Last updated

Tier 2.1
Tier Description Relational error
Error Category E2102
Error Category Message Values inconsistently specified (multi record, single file)
Rule Type Two Record Type (1 to 1)
File Segment Number CLT00002
Data Element Name CLAIM-HEADER-RECORD-LT.ICF-IID-DAYS
Validation Logic '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'
Rule Definition If type of service is intermediate care facility (ICF/IIDICF/IID) services on a non-denied claim line from an LT file, then ICF IID days must be populated on the claim.
Denominator Logic # of LT claims with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' AND with CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE equal to '046'