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TMSIS Dataguide Medicaid.gov
Version 3.36.0

RULE-1449

Validation Rule
Last updated

No Updates

Tier 2.0
Tier Description Relational error
Error Category E2001
Error Category Message Values inconsistently specified (single record type, single record)
Rule Type One Record Type (Single Record)
File Segment Number COT00002
Data Element Name CLAIM-HEADER-RECORD-OT.OCCURRENCE-CODE-EFF-DATE-02
Validation Logic 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for OCCURRENCE-CODE-02, then CLAIM-HEADER-RECORD-OT has a valid, non-null value for OCCURRENCE-CODE-EFF-DATE-02'
Rule Definition If a non-denied OT claim has a value populated for occurrence code 02, then occurrence code effective date 02 must be populated.
Denominator Logic # of OT claim headers with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-OT.OCCURRENCE-CODE-02 equal to a valid, non-null value