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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-898

Validation Rule
Last updated

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-2 • CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-3 • CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-4 • CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-5
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686', then The values of the following fields should be unique for each CLAIM-HEADER-RECORD-LT record: DIAGNOSIS-CODE-1, DIAGNOSIS-CODE-2, DIAGNOSIS-CODE-3, DIAGNOSIS-CODE-4, DIAGNOSIS-CODE-5'
Rule Definition If at least two of the 6 diagnosis codes are populated on a non-denied, non-void claim from an LT file, then the diagnosis code values reported must be unique values.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', and with CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1' and with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'