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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-7571

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 CLT00003
Data Element Name CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE • CLAIM-HEADER-RECORD-LT.ICN-ORIG • CLAIM-HEADER-RECORD-LT.ICN-ADJ • CLAIM-HEADER-RECORD-LT.ADJUDICATION-DATE • CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND
Validation Logic if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY equals 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR equals '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM equals 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type CLAIM-LINE-RECORD-LT that matches on the join keys(CLAIM-LINE-RECORD-LTnull, CLAIM-HEADER-RECORD-LTnull)
Rule Definition All denied LT claim header records must have a corresponding claim line record.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY equals 'F2' and with CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR equals '0' and with CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM equals 'Z' and with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is equal to one of the following: '26', '87', '542', '585', '654'