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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-922

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.ADMISSION-DATE • CLAIM-HEADER-RECORD-LT.ADJUDICATION-DATE
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is not equal to one of the following: '2', 'B', 'V' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for ADMISSION-DATE and CLAIM-HEADER-RECORD-LT has a valid, non-null value for ADJUDICATION-DATE, then CLAIM-HEADER-RECORD-LT.ADMISSION-DATE is less than or equal to CLAIM-HEADER-RECORD-LT.ADJUDICATION-DATE'
Rule Definition If admission date and adjudication date are populated on a non-denied claim from an LT file that is not a Medicaid or Medicaid-expansion, S-CHIP, or Other Capitated Payment, then the admission date value reported must be before or equal to the adjudication date value reported.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM not in: '2', 'B', 'V' AND with CLAIM-HEADER-RECORD-LT.ADMISSION-DATE equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-LT.ADJUDICATION-DATE equal to a valid, non-null value