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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-412

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-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 DIAGNOSIS-RELATED-GROUP, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for DIAGNOSIS-RELATED-GROUP-IND'
Rule Definition If a non-denied IP claim diagnosis related group is populated, then the diagnosis related group indicator must be populated.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-IP.DIAGNOSIS-RELATED-GROUP equal to a valid, non-null value