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TMSIS Dataguide Medicaid.gov
Version 3.29.0

RULE-1796

Validation Rule
Last updated

Tier 2.1
Tier Description Relational error
Error Category E2102
Error Category Message Values inconsistently specified (multi record, single file)
Rule Type Two Record Type (1 to Many)
File Segment Number CRX00002
Data Element Name CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS • CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT
Validation Logic 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT, then CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT is equal to the sum of all CLAIM-LINE-RECORD-RX.MEDICARE-DEDUCTIBLE-AMT values, where CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654''
Rule Definition If the total Medicare deductible amount is populated on a non-denied claim from an RX file, then the total Medicare deductible amount is equal to the sum of all non-denied line-level Medicare deductible amounts.
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-DENIED-INDICATOR not equal to '0' AND with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM not equal to 'Z' AND with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS not in '26', '026', '87', '087', '542', '585', '654' AND with CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT valid, non-null