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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-7913

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 CLT00002
Data Element Name CLAIM-HEADER-RECORD-LT.BILLING-PROV-TAXONOMY
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then If the BILLING-PROV-TAXONOMY field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
Rule Definition If the billing provider taxonomy is populated on a non-denied claim from an LT file, and is a Medicaid-expansion CHIP Encounter or separate CHIP Encounter claim then the billing provider taxonomy value reported must be in the list of valid values for provider taxonomy.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and with CLAIM-HEADER-RECORD-LT.BILLING-PROV-TAXONOMY equal to a non-null value