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TMSIS Dataguide Medicaid.gov
Version 3.30.0

RULE-1668

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 COT00002
Data Element Name PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE
Validation Logic 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NPI-NUM, then there are greater than 0 PROV-IDENTIFIERS records with matching join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2''
Rule Definition If a claim is a non-denied, non-void claim from an OT file, and the claim line servicing provider NPI number is populated, then for matching records in provider identifiers, the provider identifier type is equal to 2 (NPI).
Denominator Logic # of OT claim lines with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and with CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-CLAIM and with CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and with CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and with CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NPI-NUM