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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-969

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.CLAIM-PYMT-REM-CODE-4
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a null or invalid value for CLAIM-PYMT-REM-CODE-3, then CLAIM-HEADER-RECORD-LT has a null or invalid value for CLAIM-PYMT-REM-CODE-4'
Rule Definition If the claim pymt rem code 3 is not populated on a non-denied claim from an LT file, then claim pymt rem code 4 must not be populated.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-LT.CLAIM-PYMT-REM-CODE-3 equal to a null or invalid value