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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-339

Validation Rule
Last updated

No Updates

Tier 3.0
Tier Description Relational error
Error Category E3002
Error Category Message Values inconsistently specified (multiple record types, multi file)
Rule Type Two Record Type (1 to 1)
File Segment Number ELG00018
Data Element Name CLAIM-HEADER-RECORD-IP.1115A-DEMONSTRATION-IND
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and (1115A-DEMONSTRATION-INFORMATION has a null or invalid value for 1115A-DEMONSTRATION-IND or 1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equals '0'), then CLAIM-HEADER-RECORD-IP has a null or invalid value for 1115A-DEMONSTRATION-IND or CLAIM-HEADER-RECORD-IP.1115A-DEMONSTRATION-IND equals '0''
Rule Definition If the 1115A demonstration information segment indicates an individual does not participate in an 1115A demonstration, then the non-denied IP claim must not have a value populated for the 1115A demonstration indicator.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' and with 1115A-DEMONSTRATION-INFORMATION has a null or invalid value for 1115A-DEMONSTRATION-IND or with 1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equal to '0'