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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-1379

Validation Rule
Last updated

Tier 1.1
Tier Description Value Error
Error Category E1103
Error Category Message Value not in specified valid value set
Rule Type Valid Value
File Segment Number COT00002
Data Element Name CLAIM-HEADER-RECORD-OT.CLAIM-PYMT-REM-CODE-1 • CLAIM-HEADER-RECORD-OT.CLAIM-PYMT-REM-CODE-2 • CLAIM-HEADER-RECORD-OT.CLAIM-PYMT-REM-CODE-3 • CLAIM-HEADER-RECORD-OT.CLAIM-PYMT-REM-CODE-4
Validation Logic 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686', then The values of the following fields should be unique for each CLAIM-HEADER-RECORD-OT record: CLAIM-PYMT-REM-CODE-1, CLAIM-PYMT-REM-CODE-2, CLAIM-PYMT-REM-CODE-3, CLAIM-PYMT-REM-CODE-4'
Rule Definition If at least two of the 4 claim payment remark codes are populated on a non-denied, non-void claim from an OT file, then the claim payment remark code values reported must be unique values.
Denominator Logic # of OT claim headers with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', and with CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'