An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-1543

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 1)
File Segment Number COT00002
Data Element Name CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM
Validation Logic 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '121', '122', then CLAIM-HEADER-RECORD-OT has a null or invalid value for BILLING-PROV-NPI-NUM'
Rule Definition If the type of service is for a capitation payment to a HMO, HIO, PACE, PCCM, or PHP plan on a non-denied claim line from an OT file, then the BILLING-PROV-NPI-NUM value must not be populated.
Denominator Logic # of OT claim lines with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS not equal to one of the following: '26', '87', '542', '585', '654' AND with CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE equal to one of the following: '119', '121', '122