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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-7517

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 CIP00002
Data Element Name CLAIM-HEADER-RECORD-IP.SERVICE-TRACKING-PAYMENT-AMT
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z', then CLAIM-HEADER-RECORD-IP has a null value for SERVICE-TRACKING-PAYMENT-AMT or CLAIM-HEADER-RECORD-IP.SERVICE-TRACKING-PAYMENT-AMT equals '0.00''
Rule Definition If a claim is a non-denied, non-service tracking claim from an IP file, then the service tracking payment amount is not populated or equal to '0.00'.
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and with CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z'