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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-353

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 CIP00002
Data Element Name CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-1 • CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-2 • CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-3 • CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-4 • CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-5 • CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-6 • CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-7 • CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-8 • CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-9 • CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-10 • CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-11 • CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-12
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then The values of the following fields should be unique for each CLAIM-HEADER-RECORD-IP record: DIAGNOSIS-CODE-1, DIAGNOSIS-CODE-2, DIAGNOSIS-CODE-3, DIAGNOSIS-CODE-4, DIAGNOSIS-CODE-5, DIAGNOSIS-CODE-6, DIAGNOSIS-CODE-7, DIAGNOSIS-CODE-8, DIAGNOSIS-CODE-9, DIAGNOSIS-CODE-10, DIAGNOSIS-CODE-11, DIAGNOSIS-CODE-12'
Rule Definition If at least two of the 12 diagnosis codes are populated on a non-denied claim from an IP file, then the diagnosis code values reported must be unique values.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2'