An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide Medicaid.gov
Version 3.28.0

RULE-1788

Validation Rule
Last updated

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.TOT-BILLED-AMT
Validation Logic 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X', then CLAIM-HEADER-RECORD-RX has a null value for TOT-BILLED-AMT or CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT equals '0.00''
Rule Definition If a claim is a non-denied service tracking claim from an RX file, then the total billed amount must be 0 or null.
Denominator Logic # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X'