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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-7577

Validation Rule
Last updated

Tier 2.1
Tier Description Relational error
Error Category E2101
Error Category Message Missing parent record (single file)
Rule Type Child Parent Rule
File Segment Number CRX00002
Data Element Name CLAIM-LINE-RECORD-RX.SUBMITTING-STATE • CLAIM-LINE-RECORD-RX.ICN-ORIG • CLAIM-LINE-RECORD-RX.ICN-ADJ • CLAIM-LINE-RECORD-RX.ADJUDICATION-DATE • CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-IND
Validation Logic if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-RX has corresponding parent record CLAIM-HEADER-RECORD-RX
Rule Definition All denied RX claim line records must have a corresponding claim header record.
Denominator Logic # of RX claim lines with CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654'