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-797

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 Many)
File Segment Number CIP00002
Data Element Name CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT is greater than or equal to the sum of all CLAIM-LINE-RECORD-IP.REVENUE-CHARGE values'
Rule Definition If the total billed amount is populated on a non-denied claim from an IP file, then the total billed amount must be greater than or equal the sum of all line-level revenue charge amounts.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-IP.PAYMENT-LEVEL-IND equal to '2' AND with CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT valid, non-null