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TMSIS Dataguide Medicaid.gov
Version 3.28.0

RULE-1702

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.NATIONAL-DRUG-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 NATIONAL-DRUG-CODE, then CLAIM-LINE-RECORD-OT.NATIONAL-DRUG-CODE is a valid National Drug Code (NDC) value'
Rule Definition If the national drug code is populated on a non-denied OT claim line, then the national drug code value reported must be in the list of valid values.
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.NATIONAL-DRUG-CODE equal to a valid, non-null value