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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-1414

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.FUNDING-CODE
Validation Logic 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the FUNDING-CODE field is populated, the value must be contained in the set of valid values with id: 'FUNDING-CODE' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
Rule Definition If the funding code is populated on a non-denied claim from an OT file, then the funding code reported must be found in the list of valid values.
Denominator Logic # of OT claim headers with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-OT.FUNDING-CODE equal to a valid, non-null value