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TMSIS Dataguide Medicaid.gov
Version 3.36.0

RULE-1826

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-HEADER-RECORD-RX.CLAIM-LINE-COUNT
Validation Logic 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for CLAIM-LINE-COUNT, then CLAIM-HEADER-RECORD-RX.CLAIM-LINE-COUNT is equal to the total number of CLAIM-LINE-RECORD-RX records'
Rule Definition If a non-denied RX claim has a value populated for claim line count, the claim header claim line count is equal to the total number of IP claim line records.
Denominator Logic # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-LINE-COUNT equal to a valid, non-null value