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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-1225

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-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE • CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE
Validation Logic 'if 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 is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-LT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-LT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE'
Rule Definition If ending date of service and adjudication date are populated on a non-denied claim line from an LT file that is not a capitated payment or premium payment, then the ending date of service value reported must be before or equal to the adjudication date value reported.
Denominator Logic # of LT claim lines with CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' AND with CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE not in: '119', '120', '121', '122' AND with CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE equal to a valid, non-null value AND with CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2'