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TMSIS Dataguide Medicaid.gov
Version 3.28.0

RULE-973

Validation Rule
Last updated

Tier 2.1
Tier Description Relational error
Error Category E2102
Error Category Message Values inconsistently specified (multi record, single file)
Rule Type Two Record Type (1 to Many)
File Segment Number CLT00002
Data Element Name CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-ALLOWED-AMT, then CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT is equal to the sum of all CLAIM-LINE-RECORD-LT.ALLOWED-AMT values'
Rule Definition If the total allowed amount is populated on a non-denied claim from an LT file, then the total allowed amount must equal the sum of all line-level allowed amounts.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-LT.PAYMENT-LEVEL-IND equal to '2' AND with CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT valid, non-null