An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-7836

Validation Rule
Last updated

Tier 2.0
Tier Description Relational error
Error Category E2001
Error Category Message Values inconsistently specified (single record type, single record)
Rule Type One Record Type (Single Record)
File Segment Number CIP00002
Data Element Name CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT • CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT • CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then (CLAIM-HEADER-RECORD-IP has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')'
Rule Definition If a claim is a non-denied, non-crossover Medicaid or M-CHIP or Separate CHIP Supplemental, original or adjustment paid claim from an IP file, then the claim must have a null value or zero value for medicare paid amount, total medicare coinsurance amount and total medicare deductible amount.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and with CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4' and with CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '0' and with CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E'