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TMSIS Dataguide Medicaid.gov
Version 3.36.0

RULE-1780

Validation Rule
Last updated

No Updates

Tier 2.0
Tier Description Relational error
Error Category E2001
Error Category Message Values inconsistently specified (single record type, single record)
Rule Type One Record Type (Single Record)
File Segment Number CRX00002
Data Element Name CLAIM-HEADER-RECORD-RX.CLAIM-PYMT-REM-CODE-2
Validation Logic 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a null or invalid value for CLAIM-PYMT-REM-CODE-1, then CLAIM-HEADER-RECORD-RX has a null or invalid value for CLAIM-PYMT-REM-CODE-2'
Rule Definition If a non-denied RX claim does not have a value populated for the claim payment rem code 1, then the claim does not have a value populated for claim payment rem code 2.
Denominator Logic # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-RX.CLAIM-PYMT-REM-CODE-1 has a null or invalid value