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TMSIS Dataguide Medicaid.gov
Version 3.28.0

RULE-1858

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.MEDICARE-HIC-NUM
Validation Logic 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-RX has a null or invalid value for MEDICARE-BENEFICIARY-IDENTIFIER, then CLAIM-HEADER-RECORD-RX has a valid, non-null value for MEDICARE-HIC-NUM'
Rule Definition If a non-denied, crossover RX claim has a value populated for medicare beneficiary ID, the RX claim must have a value populated for medicare hic number.
Denominator Logic # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equal to '1' and with CLAIM-HEADER-RECORD-RX.MEDICARE-BENEFICIARY-IDENTIFIER equal to a null or invalid value