RULE-7401

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Tier	1.1
Tier Description	Missing Value Error
Error Category	E1105
Error Category Message	Data Element Value is Missing
Rule Type	One Record Type (Single Record)
File Segment Number	CLT00002
Data Element Name	CLAIM-HEADER-RECORD-LT.SERVICE-TRACKING-PAYMENT-AMT
Validation Logic	'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-HEADER-RECORD-LT.SERVICE-TRACKING-PAYMENT-AMT does not equal '0.00''
Rule Definition	If a claim is a non-denied, non-void claim from an LT file, and is a Medicaid/Medicaid-expansion CHIP or S-CHIP service tracking claim and is an original claim or a replacement/resubmission claim payment then the claim header service tracking payment amount must be populated and does not equal '0'.
Denominator Logic	# of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and with CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and with CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'

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Published Date	Data Guide Version	Validation Rule	Action	Field	Before	After
03/11/2022	3.0.0	RULE-7401	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT'	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-HEADER-RECORD-LT.SERVICE-TRACKING-PAYMENT-AMT is not equal to '0’
09/11/2020	2.4.0	RULE-7401	ADD	Data Dictionary - Validation Rules	N/A	if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT'