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TMSIS Dataguide Medicaid.gov
Version 3.36.0

RULE-580

Validation Rule
Last updated

01/31/2020

Tier 1.1
Tier Description Value Error
Error Category E1103
Error Category Message Value not in specified valid value set
Rule Type Valid Value
File Segment Number CIP00002
Data Element Name CLAIM-HEADER-RECORD-IP.OCCURRENCE-CODE-01
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'
Rule Definition If the occurrence code 01 is populated on a non-denied claim from an IP file, then the occurrence code 01 value reported must be in the list of valid values for 'occurrence code'.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-IP.OCCURRENCE-CODE-01 equal to a valid, non-null value