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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-1367

Validation Rule
Last updated

No Updates

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 COT00002
Data Element Name CLAIM-HEADER-RECORD-OT.ADJUDICATION-DATE • FILE-HEADER-RECORD-OT.END-OF-TIME-PERIOD
Validation Logic 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '2', 'B', 'V' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and FILE-HEADER-RECORD-OT has a valid, non-null value for END-OF-TIME-PERIOD, then CLAIM-HEADER-RECORD-OT.ADJUDICATION-DATE is less than or equal to FILE-HEADER-RECORD-OT.END-OF-TIME-PERIOD'
Rule Definition If adjudication date is populated on a non-denied claim from an OT file that is not a Medicaid or Medicaid-expansion, S-CHIP, or Other Capitated Payment and end of time period is populated on the file header, then the adjudication value reported must be before or equal to the end of time period value reported.
Denominator Logic # of OT claims with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not in: '2', 'B', 'V' AND with CLAIM-HEADER-RECORD-OT.ADJUDICATION-DATE equal to a valid, non-null value AND with FILE-HEADER-RECORD-OT.END-OF-TIME-PERIOD equal to a valid, non-null value