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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-7494

Validation Rule
Last updated

Tier 1.1
Tier Description Value Error
Error Category E1102
Error Category Message Value does not match specification
Rule Type One Record Type (Single Record)
File Segment Number COT00002
Data Element Name CLAIM-HEADER-RECORD-OT.UNDER-SUPERVISION-OF-PROV-NPI
Validation Logic 'if 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.ADJUSTMENT-IND does not equal '1' 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 non-null value for UNDER-SUPERVISION-OF-PROV-NPI, then CLAIM-HEADER-RECORD-OT.UNDER-SUPERVISION-OF-PROV-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file'
Rule Definition If a claim is a non-denied, non-void claim from an OT file and the under supervision of provider NPI is populated then claim header under supervision of provider NPI exists in the NPPES NPI data file.
Denominator Logic # of OT claim headers with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and with CLAIM-HEADER-RECORD-OT has a non-null value for UNDER-SUPERVISION-OF-PROV-NPI