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TMSIS Dataguide Medicaid.gov
Version 3.36.0

RULE-1884

Validation Rule
Last updated

No Updates

Tier 1.1
Tier Description Value Error
Error Category E1102
Error Category Message Value does not match specification
Rule Type One Record Type (Single Record)
File Segment Number CRX00002
Data Element Name CLAIM-HEADER-RECORD-RX.HEALTH-HOME-ENTITY-NAME
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 HEALTH-HOME-ENTITY-NAME, then CLAIM-HEADER-RECORD-RX.HEALTH-HOME-ENTITY-NAME does not contain any pipe (|) or asterisk (*) characters'
Rule Definition If the health home entity name is populated on a non-denied claim from an RX file, then the health home entity name reported must not contain any pipe or asterisk characters.
Denominator Logic # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-RX.HEALTH-HOME-ENTITY-NAME equal to a valid, non-null value