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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-7431

Validation Rule
Last updated

Tier 2.1
Tier Description Relational error
Error Category E2102
Error Category Message Values inconsistently specified (multi record, single file)
Rule Type Two Record Type (1 to 1)
File Segment Number CIP00003
Data Element Name CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE • CLAIM-HEADER-RECORD-IP.ICN-ORIG • CLAIM-HEADER-RECORD-IP.ICN-ADJ • CLAIM-HEADER-RECORD-IP.ADJUDICATION-DATE • CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND
Validation Logic if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type CLAIM-LINE-RECORD-IP that matches on the join keys(CLAIM-LINE-RECORD-IPnull, CLAIM-HEADER-RECORD-IPnull)
Rule Definition All non-denied IP claim header records must have a corresponding claim line record.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to 'Z' and with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'