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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-7344

Validation Rule
Last updated

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 CRX00002
Data Element Name CLAIM-HEADER-RECORD-RX.ICN-ADJ
Validation Logic 'if CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '4', '1', then CLAIM-HEADER-RECORD-RX has a non-null value for ICN-ADJ'
Rule Definition If a segment is an RX claim header and has an adjustment indicator that is a replacement or resubmission payment or a void, reversal or canceled payment, then icn adj must be populated.
Denominator Logic # of RX claim headers with CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equal to '4', '1'