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TMSIS Dataguide Medicaid.gov
Version 3.28.0

RULE-1639

Validation Rule
Last updated

Tier 3.0
Tier Description Relational error
Error Category E3002
Error Category Message Values inconsistently specified (multiple record types, multi file)
Rule Type Three Record Type Rule
File Segment Number ELG00002
Data Element Name PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH • CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-DATE
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 PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-LINE-RECORD-OT has a valid, non-null value for PROCEDURE-CODE-DATE, then CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'
Rule Definition If a non-denied OT claim has a value populated for procedure code date and the primary demographics eligibility segment has a value populated for date of death, the OT claim procedure code date must be less than oe equal to the primary demographics eligibility segment date of death.
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 in: '26', '87', '542', '585', '654' and with PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH equal to a valid, non-null value and with CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-DATE equal to a valid, non-null value