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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-7515

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 COT00002
Data Element Name CLAIM-HEADER-RECORD-OT.SERVICE-TRACKING-TYPE
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z', then CLAIM-HEADER-RECORD-OT has a null value for SERVICE-TRACKING-TYPE or CLAIM-HEADER-RECORD-OT.SERVICE-TRACKING-TYPE is equal to one of the following: '0', '00''
Rule Definition If a claim is a non-denied, non-service tracking claim from an OT file, then the service tracking type is not populated or equal to '0' or '00'.
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and with CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z'