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-892

Validation Rule
Last updated

No Updates

Tier 2.0
Tier Description Relational error
Error Category E2001
Error Category Message Values inconsistently specified (single record type, single record)
Rule Type One Record Type (Single Record)
File Segment Number CLT00002
Data Element Name CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-1 • CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-FLAG-1
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for DIAGNOSIS-CODE-1, then when CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-FLAG-1 is '1', CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-1 should be a valid value in 'ICD-9-DIAGNOSIS-CODE'. when CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-FLAG-1 is '2', CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-1 should be a valid value in 'ICD-10-DIAGNOSIS-CODE'.'
Rule Definition If the first diagnosis code is populated on a non-denied claim from an LT file, then the value for the first diagnosis code must be a valid value from the list of values for diagnosis codes corresponding to the first diagnosis code flag.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-1 equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-FLAG-1 in: '1', '2'