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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-717

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.OUTLIER-DAYS
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.OUTLIER-CODE equals '01', then CLAIM-HEADER-RECORD-IP has a valid, non-null value for OUTLIER-DAYS'
Rule Definition If a non-denied IP claim has a value for outlier code equal to '1', then the outlier days 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.OUTLIER-CODE equal to '01'