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TMSIS Dataguide Medicaid.gov
Version 3.30.0

RULE-1682

Validation Rule
Last updated

Tier 1.1
Tier Description Value Error
Error Category E1102
Error Category Message Value does not match specification
Rule Type Two Record Type (1 to 1)
File Segment Number COT00002
Data Element Name CLAIM-LINE-RECORD-OT.ORIGINATION-ZIP-CODE
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 has a valid, non-null value for ORIGINATION-ZIP-CODE, then CLAIM-LINE-RECORD-OT.ORIGINATION-ZIP-CODE is either a 5-digit or 9-digit number'
Rule Definition If a claim is a non-denied claim from an OT file, then the origination zip-code value reported must submitted as either 9(5) or 9(9).
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 CLAIM-LINE-RECORD-OT.ORIGINATION-ZIP-CODE equal to a valid, non-null value