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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-767

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 CIP00002
Data Element Name CLAIM-LINE-RECORD-IP.MSIS-IDENTIFICATION-NUM
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X', then CLAIM-LINE-RECORD-IP.MSIS-IDENTIFICATION-NUM starts with the '&' symbol'
Rule Definition If MSIS identification number is populated on a non-denied claim line on a service tracking claim from an IP file, then the MSIS identification number reported must start with the '&' (ampersand) symbol.
Denominator Logic # of IP claim lines with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' AND with CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM in: '4', 'D', 'X' AND with CLAIM-LINE-RECORD-IP.MSIS-IDENTIFICATION-NUM equal to a valid, non-null value