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TMSIS Dataguide Medicaid.gov
Version 3.38.0

RULE-7891

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-LINE-RECORD-RX.LINE-ADJUSTMENT-IND
Validation Logic 'if CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-LINE-RECORD-RX has a non-null value for LINE-ADJUSTMENT-IND, then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-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 line adjustment indicator is populated on a claim line from an RX file, then the line adjustment indicator value reported must be in the list of valid values for line adjustment indicator.
Denominator Logic # of RX claim lines with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and with CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-IND equal to a non-null value