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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-1637

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-LINE-RECORD-OT.PROCEDURE-CODE-DATE • CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE
Validation Logic 'if 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 has a valid, non-null value for PROCEDURE-CODE-DATE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-DATE is less than or equal to CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE'
Rule Definition If procedure code date and ending date of service are populated on a non-denied claim line from an OT file, then the procedure code date value reported must be before or equal to the ending date of service value reported.
Denominator Logic # of OT claim lines with CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' AND with CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-DATE equal to a valid, non-null value AND with CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2'