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TMSIS Dataguide Medicaid.gov
Version 3.36.0

RULE-7630

Validation Rule
Last updated

06/24/2022

Tier 1.0
Tier Description Formatting Error
Error Category E1001
Error Category Message Value illegal for specified data type
Rule Type Parse Rule
File Segment Number CRX00002
Data Element Name CLAIM-LINE-RECORD-RX.IHS-SERVICE-IND
Validation Logic if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1)
Rule Definition If a claim line is a non-denied claim from an RX file, then the IHS service indicator value reported must be compatible with the specified T-MSIS picture format: X(1).
Denominator Logic # of RX claim lines with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'