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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-411

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.SUBMITTING-STATE • CLAIM-HEADER-RECORD-IP.DIAGNOSIS-RELATED-GROUP-IND
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for SUBMITTING-STATE and CLAIM-HEADER-RECORD-IP has a valid, non-null value for DIAGNOSIS-RELATED-GROUP-IND, then CLAIM-HEADER-RECORD-IP.DIAGNOSIS-RELATED-GROUP-IND is a valid diagnosis related group (DRG) indicator with state/group corresponding to CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE'
Rule Definition If a non-denied IP claim has a value populated for submitting state and a value populated for diagnosis related group indicator, the diagnosis related group indicator values in positions 1-2 must match the value for submitting state.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE equal to a valid, non-null value and with CLAIM-HEADER-RECORD-IP.DIAGNOSIS-RELATED-GROUP-IND equal to a valid, non-null value