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TMSIS Dataguide Medicaid.gov
Version 3.28.0

RULE-1659

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.TYPE-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 TOOTH-SURFACE-CODE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '013', '029', '015', '028''
Rule Definition If tooth surface code is populated on a non-denied claim line from an OT file, then the type of service value reported must be for medical and surgical services of a dentist, dental services, medical or other remedial care or services other than physicians' services provided by licensed practitioners, or clinic services.
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.TOOTH-SURFACE-CODE equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2'