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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-1863

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.DATE-PRESCRIBED • CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE
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 DATE-PRESCRIBED and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PRESCRIPTION-FILL-DATE, then CLAIM-HEADER-RECORD-RX.DATE-PRESCRIBED is less than or equal to CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE'
Rule Definition If date prescribed and prescription fill date are populated on a non-denied claim from an RX file, then the date prescribed value reported must be before or equal to the prescription fill date value reported.
Denominator Logic # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-RX.DATE-PRESCRIBED equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE equal to a valid, non-null value