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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-575

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.MEDICAID-COV-INPATIENT-DAYS • CLAIM-HEADER-RECORD-IP.ADMISSION-DATE • CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE
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 MEDICAID-COV-INPATIENT-DAYS and CLAIM-HEADER-RECORD-IP has a valid, non-null value for ADMISSION-DATE and CLAIM-HEADER-RECORD-IP has a valid, non-null value for DISCHARGE-DATE, then CLAIM-HEADER-RECORD-IP.MEDICAID-COV-INPATIENT-DAYS is less than or equal to double the number of days between between CLAIM-HEADER-RECORD-IP.ADMISSION-DATE and CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE, plus one day'
Rule Definition If Medicaid covered inpatient days, admission date, and discharge date are populated on a non-denied claim from an IP file, then the Medicaid covered inpatient days value reported must be less than or equal to double the number of days between admission date reported and discharge date reported, plus one day.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-IP.MEDICAID-COV-INPATIENT-DAYS equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-IP.ADMISSION-DATE equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE equal to a valid, non-null value