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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-1391

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 Many)
File Segment Number COT00002
Data Element Name CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT
Validation Logic 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT is equal to the sum of all CLAIM-LINE-RECORD-OT.BILLED-AMT values'
Rule Definition If the total billed amount is populated on a non-denied claim from an OT file, then the total billed amount must equal the sum of all line-level billed amounts.
Denominator Logic # of OT claim headers with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-OT.PAYMENT-LEVEL-IND equal to '2' AND with CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT valid, non-null