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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-1155

Validation Rule
Last updated

No Updates

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.NURSING-FACILITY-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 NURSING-FACILITY-DAYS and CLAIM-HEADER-RECORD-LT.NURSING-FACILITY-DAYS does not equal '0', then CLAIM-HEADER-RECORD-LT.NURSING-FACILITY-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 beginning date of service and ending date of service are populated on a non-denied LT claim, then the nursing facility days value must be less than or equal to the days between the beginning date of service and ending date of service plus one day.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-LT.NURSING-FACILITY-DAYS equals a valid, non-null value AND with CLAIM-HEADER-RECORD-LT.NURSING-FACILITY-DAYS does not equal 0