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TMSIS Dataguide Medicaid.gov
Version 3.28.0

RULE-1260

Validation Rule
Last updated

Tier 3.0
Tier Description Relational error
Error Category E3002
Error Category Message Values inconsistently specified (multiple record types, multi file)
Rule Type Three Record Type Rule
File Segment Number ELG00002
Data Element Name CLAIM-LINE-RECORD-LT.XIX-MBESCBES-CATEGORY-OF-SERVICE
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 PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-LT.XIX-MBESCBES-CATEGORY-OF-SERVICE is not equal to one of the following: '14', '35', '42', '44''
Rule Definition If a non-denied LT claim line has XIX MBESCBES category of service equal to pregnancy-related services, then primary demographics eligibility segment must not be populated with the value 'M' for sex.
Denominator Logic # of LT claim headers 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 PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equal to 'M'