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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-7295

Validation Rule
Last updated

Tier 2.0
Tier Description Relational error
Error Category E2002
Error Category Message Values inconsistently specified (single record type, multiple records)
Rule Type Two Record Type (1 to 1)
File Segment Number COT00002
Data Element Name CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM
Validation Logic 'if CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '138', '139', '140', '141', '142', '143', '144' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B''
Rule Definition
Denominator Logic