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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-807

Validation Rule
Last updated

Tier 2.0
Tier Description Relational error
Error Category E2002
Error Category Message Values inconsistently specified (single record type, multiple records)
Rule Type Two Record Type (1 to 1)
File Segment Number CIP00002
Data Element Name CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE
Validation Logic 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '001', '058', '060', '084', '086', '090', '091', '092', '093', '123', '132', '135', '136', '137''
Rule Definition If the type of service is populated on a non-denied claim line from an IP file, then the type of service value reported must represent hospital-based services.
Denominator Logic # of IP claim lines with CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' AND with CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2'