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TMSIS Dataguide Medicaid.gov
Version 3.36.0

RULE-833

Validation Rule
Last updated

Tier 1.1
Tier Description Value Error
Error Category E1102
Error Category Message Value does not match specification
Rule Type Two Record Type (1 to 1)
File Segment Number CIP00002
Data Element Name CLAIM-LINE-RECORD-IP.HCPCS-RATE
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 CLAIM-LINE-RECORD-IP has a valid, non-null value for HCPCS-RATE, then CLAIM-LINE-RECORD-IP.HCPCS-RATE does not contain any pipe (|) or asterisk (*) characters'
Rule Definition If the HCPCS rate is populated on a non-denied IP claim line file, then the HCPCS rate must not contain any pipe or asterisk characters.
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 CLAIM-LINE-RECORD-IP.HCPCS-RATE equal to a valid, non-null value