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-7887

Validation Rule
Last updated

Tier 1.1
Tier Description Value Error
Error Category E1103
Error Category Message Value not in specified valid value set
Rule Type Valid Value
File Segment Number CRX00002
Data Element Name CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND
Validation Logic 'if CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then If the ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
Rule Definition If the type of claim is a service tracking and adjustment indicator is populated on a claim header from an RX file, then the adjustment indicator value reported must be in the list of valid values for adjustment indicator.
Denominator Logic # of RX claim headers with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and with CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equal to a non-null value