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TMSIS Dataguide Medicaid.gov
Version 3.36.0

RULE-6179

Validation Rule
Last updated

Tier 1.0
Tier Description Formatting Error
Error Category E1001
Error Category Message Value illegal for specified data type
Rule Type Parse Rule
File Segment Number COT00002
Data Element Name CLAIM-LINE-RECORD-OT.LINE-ADJUSTMENT-REASON-CODE
Validation Logic if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3)
Rule Definition If a claim line is a non-denied claim line from an OT file, then the line adjustment reason code value reported must be compatible with specified T-MSIS picture format: X(3).
Denominator Logic # of OT claim lines with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654'