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TMSIS Dataguide Medicaid.gov
Version 3.36.0

RULE-1227

Validation Rule
Last updated

08/21/2020

Tier 2.1
Tier Description Relational error
Error Category E2102
Error Category Message Values inconsistently specified (multi record, single file)
Rule Type Three Record Type Rule
File Segment Number CLT00002
Data Element Name CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE • FILE-HEADER-RECORD-LT.END-OF-TIME-PERIOD
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 FILE-HEADER-RECORD-LT has a valid, non-null value for END-OF-TIME-PERIOD 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 FILE-HEADER-RECORD-LT.END-OF-TIME-PERIOD'
Rule Definition If ending date of service is populated on a non-denied claim line from an LT file that is not a capitated payment or premium payment and end of time period is populated on the file header, then the ending date of service value reported must be before or equal to the end of time period 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 FILE-HEADER-RECORD-LT.END-OF-TIME-PERIOD equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2'