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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-1943

Validation Rule
Last updated

Tier 1.1
Tier Description Value Error
Error Category E1102
Error Category Message Value does not match specification
Rule Type Two Record Type (1 to 1)
File Segment Number CRX00002
Data Element Name CLAIM-LINE-RECORD-RX.DAYS-SUPPLY
Validation Logic 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for DAYS-SUPPLY, then CLAIM-LINE-RECORD-RX.DAYS-SUPPLY is greater than or equal to -365 AND less than or equal to 365'
Rule Definition If the days supply is populated on a non-denied claim line from an RX file, then the days supply value reported must greater than or equal to -365 and less than or equal to 365.
Denominator Logic # of RX claim lines with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' AND with CLAIM-LINE-RECORD-RX.DAYS-SUPPLY equal to a valid, non-null value