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TMSIS Dataguide Medicaid.gov
Version 3.36.0

RULE-7561

Validation Rule
Last updated

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 CLT00003
Data Element Name CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT
Validation Logic 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-LT has a null value for MEDICAID-PAID-AMT or CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT equals '0.00''
Rule Definition If an LT claim line is for a denied claim, then the medicaid paid amount has a missing or zero value.
Denominator Logic # of LT claim lines with CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654'