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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-534

Validation Rule
Last updated

Tier 2.1
Tier Description Relational error
Error Category E2102
Error Category Message Values inconsistently specified (multi record, single file)
Rule Type Two Record Type (1 to Many)
File Segment Number CIP00002
Data Element Name CLAIM-HEADER-RECORD-IP.TOT-ALLOWED-AMT
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-ALLOWED-AMT, then CLAIM-HEADER-RECORD-IP.TOT-ALLOWED-AMT is equal to the sum of all CLAIM-LINE-RECORD-IP.ALLOWED-AMT values'
Rule Definition If the payment level indicator is for a claim detail level payment and the total allowed amount is populated on a non-denied claim from an LT file, then the total allowed amount value reported must be equal to the sum of all the allowed amount values reported on the associated claim lines.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-IP.PAYMENT-LEVEL-IND equal to '2' AND with CLAIM-HEADER-RECORD-IP.TOT-ALLOWED-AMT equal to a valid, non-null value