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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-808

Validation Rule
Last updated

Tier 3.0
Tier Description Relational error
Error Category E3002
Error Category Message Values inconsistently specified (multiple record types, multi file)
Rule Type Three Record Type Rule
File Segment Number ELG00002
Data Element Name CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE does not equal '086''
Rule Definition If a non-denied IP claim and a primary demographics eligibility segment has a value populated for sex that equals 'male' then the RX claim line must not have a type of service populated that equals other pregnancy-related procedures.
Denominator Logic # of IP claim lines with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' and with PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equal to 'M'