|
12/06/2024
|
3.32.0 |
RULE-2013
|
Delete |
Data Dictionary - Validation Rules |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.PREGNANCY-IND equals '1',
then PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'F'' |
N/A |
|
12/06/2024
|
3.32.0 |
RULE-827
|
Delete |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'
and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M',
then CLAIM-LINE-RECORD-IP.XIX-MBESCBES-CATEGORY-OF-SERVICE is not equal to one of the following: '14', '35', '42', '44'' |
N/A |
|
12/06/2024
|
3.32.0 |
RULE-1260
|
Delete |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'
and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M',
then CLAIM-LINE-RECORD-LT.XIX-MBESCBES-CATEGORY-OF-SERVICE is not equal to one of the following: '14', '35', '42', '44'' |
N/A |
|
12/06/2024
|
3.32.0 |
RULE-1694
|
Delete |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'
and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M',
then CLAIM-LINE-RECORD-OT.XIX-MBESCBES-CATEGORY-OF-SERVICE is not equal to one of the following: '14', '35', '42', '44'' |
N/A |
|
12/06/2024
|
3.32.0 |
RULE-1958
|
Delete |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'
and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M',
then CLAIM-LINE-RECORD-RX.XIX-MBESCBES-CATEGORY-OF-SERVICE is not equal to one of the following: '14', '35', '42', '44'' |
N/A |
|
12/06/2024
|
3.32.0 |
RULE-1657
|
Delete |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'
and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M',
then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '025', '085'' |
N/A |
|
12/06/2024
|
3.32.0 |
RULE-808
|
Delete |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'
and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M',
then CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE does not equal '086'' |
N/A |
|
12/06/2024
|
3.32.0 |
RULE-1939
|
Delete |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'
and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M',
then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE does not equal '086'' |
N/A |
|
12/06/2024
|
3.32.0 |
RULE-2155
|
Delete |
Data Dictionary - Validation Rules |
if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '4',
then PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'F'' |
N/A |
|
12/06/2024
|
3.32.0 |
RULE-7367
|
Delete |
Data Dictionary - Validation Rules |
if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM then PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null value for SEX
then PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null value for SEX
|
N/A |
|
02/16/2024
|
3.19.0 |
RULE-7985
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C',
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
02/16/2024
|
3.19.0 |
RULE-7986
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C',
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
02/16/2024
|
3.19.0 |
RULE-7987
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
02/16/2024
|
3.19.0 |
RULE-7988
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
09/22/2023
|
3.13.0 |
RULE-7262
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-IP has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMTand CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT does not equal '0.00',then CLAIM-LINE-RECORD-IP has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT |
|
09/22/2023
|
3.13.0 |
RULE-7263
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-LT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A'
aand CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT does not equal '0.00',
then CLAIM-LINE-RECORD-LT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT |
|
09/22/2023
|
3.13.0 |
RULE-7265
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-RX has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A'
and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT does not equal '0.00',
then CLAIM-LINE-RECORD-RX has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT |
|
09/22/2023
|
3.13.0 |
RULE-7892
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A'
and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT does not equal '0.00',
then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT |
|
09/22/2023
|
3.13.0 |
RULE-7446
|
UPDATE |
Data Dictionary - Validation Rules |
#of RX claim lines with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal ''F2'' and with CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal ''0'' and with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal ''Z'' and with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: ''26'', ''026'', ''87'', ''087'', ''542'', ''585'', ''654'' and with CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to ''0'' or ''4'' and with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: ''1'', ''3'', ''A'', ''C'' and with CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: ''26'', ''026'', ''87'', ''087'', ''542'', ''585'', ''654'' and with CLAIM-LINE-RECORD-RX has a non-null value for SERVICING-PROV-NUM' |
#of RX claim headerswith CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and with CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'and with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and with CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4'and with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C'and with CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM |
|
09/08/2023
|
3.12.0 |
RULE-7736
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMTand CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT does not equal '0.00', then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT |
|
08/11/2023
|
3.11.0 |
RULE-7980
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBLE-CONTACT-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM, and ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-ZIP-CODE then the concatenation of ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-STATE and substring(ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ZIP-CODE, 0, 5) must be contained in the set of valid values with id: 'ZIP-CODE' and (if ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE is non-null then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date) |
|
08/11/2023
|
3.11.0 |
RULE-7532
|
UPDATE |
Data Dictionary - Validation Rules |
if ELIGIBLE-CONTACT-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM,
then ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-COUNTY-CODE
and the concatenation of ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-STATE
and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-COUNTY-CODE must be contained in the set of valid values with id: 'COUNTY'
and (if ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE is non-null
then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date)and ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-ZIP-CODE
and the concatenation of ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-STATE and substring(ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ZIP-CODE, 0, 5) must be contained in the set of valid values with id: 'ZIP-CODE'
and (if ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE is non-null
then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date)' |
f ELIGIBLE-CONTACT-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM, and ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-COUNTY-CODE then the concatenation of ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-STATE and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-COUNTY-CODE must be contained in the set of valid values with id: 'COUNTY' and (if ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE is non-null then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date) |
|
08/11/2023
|
3.11.0 |
RULE-7744
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM equals '3' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals ‘1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08' |
|
08/11/2023
|
3.11.0 |
RULE-7743
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM equals '3' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '04', '08' |
|
08/11/2023
|
3.11.0 |
RULE-7741
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM equals '3' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '04', '08' |
|
08/11/2023
|
3.11.0 |
RULE-7742
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM equals '3' and CLAIM-HEADER-RECORD- RX.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for PRESCRIPTION-FILL-DATE, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08' |
|
08/11/2023
|
3.11.0 |
Rule-7981
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM equals '1' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals ‘1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08' |
|
08/11/2023
|
3.11.0 |
Rule-7982
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM equals '1' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08' |
|
08/11/2023
|
3.11.0 |
Rule-7983
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM equals '1' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08' |
|
08/11/2023
|
3.11.0 |
Rule-7984
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM equals '1' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for PRESCRIPTION-FILL-DATE, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08' |
|
08/11/2023
|
3.11.0 |
Rule-7559
|
UPDATE |
Data Dictionary - Validation Rules |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE, then VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-BENEFICIARY-IDENTIFIER or VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-HIC-NUM' |
N/A |
|
08/11/2023
|
3.11.0 |
Rule-7194
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal ‘F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686’ and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
|
07/14/2023
|
3.10.0 |
Rule-7412
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '3'
and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '1'
and CLAIM-HEADER-RECORD-IP has a valid, non-null value for MSIS-IDENTIFICATION-NUM
and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE,
then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys
and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE
and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE
and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1'
and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '3'
and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '1'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-IP has a valid, non-null value for MSIS-IDENTIFICATION-NUM
and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE,
then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys
and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE
and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE
and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals ‘1'
and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08' |
|
07/14/2023
|
3.10.0 |
Rule-7413
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE,
then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10' |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3'
and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '1'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-LT has a valid, non-null value for MSIS-IDENTIFICATION-NUM
and CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE,
then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys
and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE
and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE
and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1'
and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08' |
|
07/14/2023
|
3.10.0 |
Rule-7414
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for PRESCRIPTION-FILL-DATE,
then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3'
and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '1'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-RX has a valid, non-null value for MSIS-IDENTIFICATION-NUM
and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for PRESCRIPTION-FILL-DATE,
then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys
and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE
and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE
and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1'
and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08' |
|
07/14/2023
|
3.10.0 |
Rule-7424
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for MSIS-IDENTIFICATION-NUM
and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE,
then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys
and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE
and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE
and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1'
and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3'
and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for MSIS-IDENTIFICATION-NUM
and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE,
then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys
and ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE
and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE
and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1'
and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: ‘01', '02', '04', '08' |
|
07/14/2023
|
3.10.0 |
Rule-7974
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT.HCBS-SERVICE-CODE is equal to '4' then CLAIM-HEADER-RECORD-OT has a non-null value for WAIVER-ID |
|
07/14/2023
|
3.10.0 |
Rule-7975
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT.HCBS-SERVICE-CODE is equal to '4' then CLAIM-HEADER-RECORD-OT has a non-null value for WAIVER-ID |
|
07/14/2023
|
3.10.0 |
Rule-7937
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT does not equal 0.00 and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-IP has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
07/14/2023
|
3.10.0 |
Rule-7938
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT does not equal 0.00 and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-LT has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
07/14/2023
|
3.10.0 |
Rule-7939
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT does not equal 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-OT has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
07/14/2023
|
3.10.0 |
Rule-7940
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT does not equal 0.00 and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-RX has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
07/14/2023
|
3.10.0 |
Rule-7945
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
07/14/2023
|
3.10.0 |
Rule-7946
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
07/14/2023
|
3.10.0 |
Rule-7947
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
07/14/2023
|
3.10.0 |
Rule-7948
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
07/14/2023
|
3.10.0 |
RULE-7949
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
07/14/2023
|
3.10.0 |
RULE-7950
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
07/14/2023
|
3.10.0 |
RULE-7951
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
07/14/2023
|
3.10.0 |
RULE-7952
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
07/14/2023
|
3.10.0 |
RULE-7953
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is greater than zero and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
07/14/2023
|
3.10.0 |
RULE-7954
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is greater than zero and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
07/14/2023
|
3.10.0 |
RULE-7955
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is greater than zero and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
07/14/2023
|
3.10.0 |
RULE-7956
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is greater than zero and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
07/14/2023
|
3.10.0 |
RULE-7921
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C'
and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NUM,
then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys,
where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' |
|
07/14/2023
|
3.10.0 |
RULE-7922
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' |
|
07/14/2023
|
3.10.0 |
RULE-7923
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' |
|
07/14/2023
|
3.10.0 |
RULE-7924
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' |
|
07/14/2023
|
3.10.0 |
RULE-7925
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NUM, then there are greater than 0 PROV-MEDICAID-ENROLLMENT records with matching join keys and the CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE are overlapping with the PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE,where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' |
|
07/14/2023
|
3.10.0 |
RULE-7926
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NUM, then there are greater than 0 PROV-MEDICAID-ENROLLMENT records with matching join keys and the CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE are overlapping with the PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE,where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' |
|
07/14/2023
|
3.10.0 |
RULE-7927
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NUM, then there are greater than 0 PROV-MEDICAID-ENROLLMENT records with matching join keys and the CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE are overlapping with the PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' |
|
07/14/2023
|
3.10.0 |
RULE-7928
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys and the PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE are overlapping with the CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' |
|
07/14/2023
|
3.10.0 |
Rule-7929
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' |
|
07/14/2023
|
3.10.0 |
Rule-7930
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' |
|
07/14/2023
|
3.10.0 |
Rule-7931
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' |
|
07/14/2023
|
3.10.0 |
Rule-7932
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' |
|
07/14/2023
|
3.10.0 |
RULE-7933
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NUM, then there are greater than 0 PROV-MEDICAID-ENROLLMENT records with matching join keys and the CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE are overlapping with the PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' |
|
07/14/2023
|
3.10.0 |
RULE-7934
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NUM, then there are greater than 0 PROV-MEDICAID-ENROLLMENT records with matching join keys and the CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE are overlapping with the PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' |
|
07/14/2023
|
3.10.0 |
RULE-7935
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NUM, then there are greater than 0 PROV-MEDICAID-ENROLLMENT records with matching join keys and the CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE are overlapping with the PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' |
|
07/14/2023
|
3.10.0 |
RULE-7936
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on the join keys and the PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE are overlapping with the CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE, where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06' |
|
07/14/2023
|
3.10.0 |
Rule-7976
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if all CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR is equal to '0' |
|
07/14/2023
|
3.10.0 |
Rule-7977
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if all CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR is equal to '0' |
|
07/14/2023
|
3.10.0 |
Rule-7978
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if all CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR is equal to '0' |
|
07/14/2023
|
3.10.0 |
Rule-7979
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if all CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR is equal to '0' |
|
06/23/2023
|
3.9.0 |
RULE-7941
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT does not equal 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-OT has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
06/23/2023
|
3.9.0 |
RULE-7942
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 2' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
|
06/23/2023
|
3.9.0 |
RULE-7943
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'B'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not equal to 0.00
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02',
then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
06/23/2023
|
3.9.0 |
RULE-7944
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '2'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is greater than zero
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02',
then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
06/23/2023
|
3.9.0 |
RULE-7957
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMTand CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT does not equal 0.00 and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-IP has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
06/23/2023
|
3.9.0 |
RULE-7958
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMTand CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT does not equal 0.00 and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-LT has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
06/23/2023
|
3.9.0 |
RULE-7959
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMTand CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT does not equal 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-OT has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
06/23/2023
|
3.9.0 |
RULE-7960
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMTand CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT does not equal 0.00 and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE then CLAIM-LINE-RECORD-RX has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
06/23/2023
|
3.9.0 |
RULE-7961
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '5' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMTand CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
06/23/2023
|
3.9.0 |
RULE-7962
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '5' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMTand CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
06/23/2023
|
3.9.0 |
RULE-7963
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '5' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
06/23/2023
|
3.9.0 |
RULE-7964
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '5' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
06/23/2023
|
3.9.0 |
RULE-7965
|
ADD |
Data Dictionary - Validation Rules |
N/A |
CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to 'E'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is not equal to 0.00
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02',
then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
06/23/2023
|
3.9.0 |
RULE-7966
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to 'E' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is not equal to 0.00
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02',
then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
06/23/2023
|
3.9.0 |
RULE-7967
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'E' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
06/23/2023
|
3.9.0 |
RULE-7968
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to 'E' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
06/23/2023
|
3.9.0 |
RULE-7969
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '5' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is greater than zero and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
06/23/2023
|
3.9.0 |
RULE-7970
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '5' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is greater than zero and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
06/23/2023
|
3.9.0 |
RULE-7971
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '5' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is greater than zero and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
06/23/2023
|
3.9.0 |
RULE-7972
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '5' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is greater than zero and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
06/02/2023
|
3.8.0 |
Rule-7901
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE |
|
06/02/2023
|
3.8.0 |
Rule-7904
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE |
|
06/02/2023
|
3.8.0 |
Rule-7903
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4',then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE |
|
06/02/2023
|
3.8.0 |
Rule-7902
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE |
|
06/02/2023
|
3.8.0 |
RULE-7913
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
06/02/2023
|
3.8.0 |
RULE-7914
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3','C', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
06/02/2023
|
3.8.0 |
RULE-7915
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
06/02/2023
|
3.8.0 |
RULE-7916
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)' |
|
06/02/2023
|
3.8.0 |
RULE-7918
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
06/02/2023
|
3.8.0 |
RULE-7919
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
06/02/2023
|
3.8.0 |
RULE-7920
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
06/02/2023
|
3.8.0 |
RULE-7917
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)' |
|
06/02/2023
|
3.8.0 |
Rule-7905
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM and TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-IP.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
|
06/02/2023
|
3.8.0 |
Rule-7906
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-LT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
|
06/02/2023
|
3.8.0 |
Rule-7907
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-OT. TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number |
|
06/02/2023
|
3.8.0 |
Rule-7908
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM and TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-RX.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number |
|
06/02/2023
|
3.8.0 |
Rule-7909
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM and TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-HEADER-RECORD-IP.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
|
06/02/2023
|
3.8.0 |
Rule-7910
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 1', 'A', then CLAIM-HEADER-RECORD-LT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
|
06/02/2023
|
3.8.0 |
Rule-7911
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-OT. TYPE-OF-CLAIM is equal to one of the following: 1', 'A', then CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
|
06/02/2023
|
3.8.0 |
Rule-7912
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM and TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-HEADER-RECORD-RX.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
|
05/12/2023
|
3.7.0 |
RULE-7530
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBLE-CONTACT-INFORMATION has a non-null value for MSIS-IDENTIFICATION-
and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-TYPE equals '01',
then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-STATE equals ELIGIBLE-CONTACT-INFORMATION.SUBMITTING-STATE
and ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-COUNTY-CODE
and the concatenation of ELIGIBLE-CONTACT-INFORMATION.SUBMITTING-STATE
and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-COUNTY-CODE must be contained in the set of valid values with id: 'COUNTY'
and (if ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE is non-null
then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date)
and ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-ZIP-CODE
and the concatenation of ELIGIBLE-CONTACT-INFORMATION.SUBMITTING-STATE and substring(ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ZIP-CODE, 0, 5) must be contained in the set of valid values with id: 'ZIP-CODE'
and (if ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE is non-null
then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date) |
|
05/12/2023
|
3.7.0 |
RULE-7532
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBLE-CONTACT-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM,
then ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-COUNTY-CODE
and the concatenation of ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-STATE and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-COUNTY-CODE must be contained in the set of valid values with id: 'COUNTY'
and (if ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE is non-null
then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date)
and ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-ZIP-CODE
and the concatenation of ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-STATE and substring(ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ZIP-CODE, 0, 5) must be contained in the set of valid values with id: 'ZIP-CODE'
and (if ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE is non-null
then ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date) |
|
05/12/2023
|
3.7.0 |
RULE-7897
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
|
05/12/2023
|
3.7.0 |
RULE-7898
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
|
05/12/2023
|
3.7.0 |
RULE-7899
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
|
05/12/2023
|
3.7.0 |
RULE-7900
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
|
05/12/2023
|
3.7.0 |
RULE-7452
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then (CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT does not equal '0.00') |
N/A |
|
05/12/2023
|
3.7.0 |
RULE-7453
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then (CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT does not equal '0.00') |
N/A |
|
05/12/2023
|
3.7.0 |
RULE-7454
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then (CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT does not equal '0.00') |
N/A |
|
05/12/2023
|
3.7.0 |
RULE-7455
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then (CLAIM-LINE-RECORD-RX has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT does not equal '0.00') |
N/A |
|
05/12/2023
|
3.7.0 |
RULE-7448
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '0'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C',then (CLAIM-HEADER-RECORD-IP has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT equals '0.00')and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT equals '0.00')and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00') |
N/A |
|
05/12/2023
|
3.7.0 |
RULE-7449
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then (CLAIM-HEADER-RECORD-LT has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00') |
N/A |
|
05/12/2023
|
3.7.0 |
RULE-7450
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then (CLAIM-LINE-RECORD-OT has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00') |
N/A |
|
05/12/2023
|
3.7.0 |
RULE-7451
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then (CLAIM-LINE-RECORD-RX has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00') |
N/A |
|
05/12/2023
|
3.7.0 |
RULE-7892
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT |
|
05/12/2023
|
3.7.0 |
RULE-7893
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-IP has a non-null value for TYPE-OF-SERVICE |
|
05/12/2023
|
3.7.0 |
RULE-7894
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-LT has a non-null value for TYPE-OF-SERVICE |
|
05/12/2023
|
3.7.0 |
RULE-7895
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-OT has a non-null value for TYPE-OF-SERVICE |
|
05/12/2023
|
3.7.0 |
RULE-7896
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-RX has a non-null value for TYPE-OF-SERVICE |
|
04/21/2023
|
3.6.0 |
Rule-7705
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '2, 'B', 'V' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
N/A |
|
04/21/2023
|
3.6.0 |
Rule-7707
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '2, 'B', 'V' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
N/A |
|
04/21/2023
|
3.6.0 |
Rule-7708
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '2, 'B', 'V' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
N/A |
|
04/21/2023
|
3.6.0 |
Rule-7701
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', 'V' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE) |
N/A |
|
04/21/2023
|
3.6.0 |
Rule-7703
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', 'V' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE) |
N/A |
|
04/21/2023
|
3.6.0 |
Rule-7704
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', 'V' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE) |
N/A |
|
04/21/2023
|
3.6.0 |
Rule-7868
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: ‘1', 'A', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7869
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: ‘1', 'A', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7870
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: ‘1', 'A', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7871
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: ‘1', 'A', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7872
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7873
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7874
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7875
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then if the LINE-ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7876
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7877
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7878
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7879
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E',then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7880
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7881
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7882
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7883
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then if the LINE-ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7884
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7885
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7886
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7887
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D',then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7888
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7889
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7890
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date) |
|
04/21/2023
|
3.6.0 |
Rule-7891
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then if the LINE-ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date) |
|
03/31/2023
|
3.5.0 |
Rule-7852
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7853
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7854
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7855
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7856
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then CLAIM-LINE-RECORD-IP.LINE-ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7857
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then CLAIM-LINE-RECORD-LT.LINE-ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7858
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then CLAIM-LINE-RECORD-OT.LINE-ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7859
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7864
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-LINE-RECORD-IP.LINE-ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7865
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-LINE-RECORD-LT.LINE-ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7866
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-LINE-RECORD-OT.LINE-ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7867
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7848
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-LINE-RECORD-IP.LINE-ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7849
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-LINE-RECORD-LT.LINE-ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7850
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-LINE-RECORD-OT.LINE-ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7851
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
RULE-7844
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
RULE-7845
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
RULE-7846
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
RULE-7847
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7860
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7861
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7862
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7863
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND must have a non-null value |
|
03/31/2023
|
3.5.0 |
Rule-7836
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then (CLAIM-HEADER-RECORD-IP has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00') |
|
03/31/2023
|
3.5.0 |
Rule-7837
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then (CLAIM-HEADER-RECORD-LT has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')' |
|
03/31/2023
|
3.5.0 |
Rule-7838
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then (CLAIM-LINE-RECORD-OT has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')' |
|
03/31/2023
|
3.5.0 |
Rule-7839
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '5', 'E' then (CLAIM-LINE-RECORD-RX has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')' |
|
03/31/2023
|
3.5.0 |
Rule-7840
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then (CLAIM-HEADER-RECORD-IP has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00') |
|
03/31/2023
|
3.5.0 |
Rule-7841
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then (CLAIM-HEADER-RECORD-LT has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')' |
|
03/31/2023
|
3.5.0 |
Rule-7842
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then (CLAIM-LINE-RECORD-OT has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')' |
|
03/31/2023
|
3.5.0 |
Rule-7843
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' then (CLAIM-LINE-RECORD-RX has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')' |
|
03/10/2023
|
3.4.0 |
Rule-2696
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record MANAGED-CARE-ACCREDITATION-ORGANIZATION has corresponding parent record MANAGED-CARE-MAIN |
|
03/10/2023
|
3.4.0 |
Rule-2593
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record MANAGED-CARE-LOCATION-AND-CONTACT-INFO has corresponding parent record MANAGED-CARE-MAIN |
|
03/10/2023
|
3.4.0 |
Rule-2675
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record MANAGED-CARE-PLAN-POPULATION-ENROLLED has corresponding parent record MANAGED-CARE-MAIN |
|
03/10/2023
|
3.4.0 |
Rule-2630
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record MANAGED-CARE-SERVICE-AREA has corresponding parent record MANAGED-CARE-MAIN |
|
03/10/2023
|
3.4.0 |
RULE-2969
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record PROV-AFFILIATED-GROUPS has corresponding parent record PROV-ATTRIBUTES-MAIN |
|
03/10/2023
|
3.4.0 |
RULE-2988
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record PROV-AFFILIATED-PROGRAMS has corresponding parent record PROV-ATTRIBUTES-MAIN |
|
03/10/2023
|
3.4.0 |
RULE-3010
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record PROV-BED-TYPE-INFO has corresponding parent record PROV-LOCATION-AND-CONTACT-INFO |
|
03/10/2023
|
3.4.0 |
RULE-2898
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record PROV-IDENTIFIERS has corresponding parent record PROV-LOCATION-AND-CONTACT-INFO |
|
03/10/2023
|
3.4.0 |
RULE-2873
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record PROV-LICENSING-INFO has corresponding parent record PROV-LOCATION-AND-CONTACT-INFO |
|
03/10/2023
|
3.4.0 |
RULE-2834
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record PROV-LOCATION-AND-CONTACT-INFO has corresponding parent record PROV-ATTRIBUTES-MAIN |
|
03/10/2023
|
3.4.0 |
RULE-2946
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record PROV-MEDICAID-ENROLLMENT has corresponding parent record PROV-ATTRIBUTES-MAIN |
|
03/10/2023
|
3.4.0 |
RULE-2926
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record PROV-TAXONOMY-CLASSIFICATION has corresponding parent record PROV-ATTRIBUTES-MAIN |
|
03/10/2023
|
3.4.0 |
RULE-3143
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION has corresponding parent record TPL-MEDICAID-ELIGIBLE-PERSON-MAIN |
|
03/10/2023
|
3.4.0 |
RULE-3120
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES has corresponding parent record TPL-ENTITY-CONTACT-INFORMATION |
|
03/10/2023
|
3.4.0 |
RULE-3085
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has corresponding parent record TPL-MEDICAID-ELIGIBLE-PERSON-MAIN |
|
02/17/2023
|
3.3.0 |
Rule-2120
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record ELIGIBILITY-DETERMINANTS has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
02/17/2023
|
3.3.0 |
RULE-2473
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record 1115A-DEMONSTRATION-INFORMATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
02/17/2023
|
3.3.0 |
RULE-2453
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record DISABILITY-INFORMATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
02/17/2023
|
3.3.0 |
RULE-2086
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record ELIGIBLE-CONTACT-INFORMATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
02/17/2023
|
3.3.0 |
RULE-2513
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record ENROLLMENT-TIME-SPAN-SEGMENT has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
02/17/2023
|
3.3.0 |
RULE-2408
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record ETHNICITY-INFORMATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
02/17/2023
|
3.3.0 |
RULE-2494
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
02/17/2023
|
3.3.0 |
RULE-2234
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record HEALTH-HOME-CHRONIC-CONDITIONS has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
02/17/2023
|
3.3.0 |
RULE-2180
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record HEALTH-HOME-SPA-PARTICIPATION-INFORMATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
02/17/2023
|
3.3.0 |
RULE-2207
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record HEALTH-HOME-SPA-PROVIDERS has corresponding parent record HEALTH-HOME-SPA-PARTICIPATION-INFORMATION |
|
02/17/2023
|
3.3.0 |
RULE-2256
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record LOCK-IN-INFORMATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
02/17/2023
|
3.3.0 |
RULE-2354
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record LTSS-PARTICIPATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
02/17/2023
|
3.3.0 |
RULE-2377
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record MANAGED-CARE-PARTICIPATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
02/17/2023
|
3.3.0 |
RULE-2279
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record MFP-INFORMATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
02/17/2023
|
3.3.0 |
RULE-2430
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record RACE-INFORMATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
02/17/2023
|
3.3.0 |
RULE-2306
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record STATE-PLAN-OPTION-PARTICIPATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
02/17/2023
|
3.3.0 |
RULE-3060
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record TPL-MEDICAID-ELIGIBLE-PERSON-MAIN has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
02/17/2023
|
3.3.0 |
RULE-2039
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record VARIABLE-DEMOGRAPHICS-ELIGIBILITY has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
02/17/2023
|
3.3.0 |
RULE-2329
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
record WAIVER-PARTICIPATION has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
08/21/2020
|
2.4.0 |
RULE-1016
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for CLAIM-LINE-COUNT, then CLAIM-HEADER-RECORD-LT.CLAIM-LINE-COUNT is equal to the total number of CLAIM-LINE-RECORD-LT records' |
|
08/21/2020
|
2.4.0 |
RULE-1151
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE equals '046', then CLAIM-HEADER-RECORD-LT has a valid, non-null value for ICF-IID-DAYS' |
|
08/21/2020
|
2.4.0 |
RULE-1203
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X' and CLAIM-LINE-RECORD-LT has a valid, non-null value for MSIS-IDENTIFICATION-NUM, then CLAIM-LINE-RECORD-LT.MSIS-IDENTIFICATION-NUM starts with the '&' symbol' |
|
08/21/2020
|
2.4.0 |
RULE-1204
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-LT has corresponding parent record CLAIM-HEADER-RECORD-LT |
|
08/21/2020
|
2.4.0 |
RULE-1212
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for LINE-NUM-ADJ and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT has a valid, non-null value for LINE-ADJUSTMENT-IND' |
|
08/21/2020
|
2.4.0 |
RULE-1213
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1215
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1216
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid date of the form CCYYMMDD |
|
08/21/2020
|
2.4.0 |
RULE-1218
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-LT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE' |
|
08/21/2020
|
2.4.0 |
RULE-1219
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-LT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and FILE-HEADER-RECORD-LT has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE is less than or equal to FILE-HEADER-RECORD-LT.END-OF-TIME-PERIOD' |
|
08/21/2020
|
2.4.0 |
RULE-1220
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-LT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-LT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-1222
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid date of the form CCYYMMDD |
|
08/21/2020
|
2.4.0 |
RULE-1225
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-LT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-LT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-1227
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-LT has a valid, non-null value for ENDING-DATE-OF-SERVICE and FILE-HEADER-RECORD-LT has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is less than or equal to FILE-HEADER-RECORD-LT.END-OF-TIME-PERIOD' |
|
08/21/2020
|
2.4.0 |
RULE-1228
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1229
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1230
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(6)V999 |
|
08/21/2020
|
2.4.0 |
RULE-1231
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(6)V999 |
|
08/21/2020
|
2.4.0 |
RULE-1232
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1233
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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-BILLED-AMT, then CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT is greater than or equal to the sum of all CLAIM-LINE-RECORD-LT.REVENUE-CHARGE values' |
|
08/21/2020
|
2.4.0 |
RULE-1234
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT has a valid, non-null value for REVENUE-CODE, then CLAIM-LINE-RECORD-LT has a valid, non-null value for REVENUE-CHARGE' |
|
08/21/2020
|
2.4.0 |
RULE-1236
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1237
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1238
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1239
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1240
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1241
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'C', '3', 'W', then CLAIM-LINE-RECORD-LT has a valid, non-null value for MEDICAID-FFS-EQUIVALENT-AMT' |
|
08/21/2020
|
2.4.0 |
RULE-1242
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BILLING-UNIT' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1243
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1244
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '009', '044', '045', '046', '047', '048', '050', '059', '133', '136', '137'' |
|
08/21/2020
|
2.4.0 |
RULE-1246
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 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.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-LT, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV- |
|
08/21/2020
|
2.4.0 |
RULE-1247
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(10) |
|
08/21/2020
|
2.4.0 |
RULE-1248
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for SERVICING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-LT.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
|
08/21/2020
|
2.4.0 |
RULE-1249
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-LINE-RECORD-LT has a valid, non-null value for SERVICING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2' |
|
08/21/2020
|
2.4.0 |
RULE-1250
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1251
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1252
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1253
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1254
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1255
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1258
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-FACILITY-TYPE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1259
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1261
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1262
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for STATE-NOTATION, then CLAIM-LINE-RECORD-LT.STATE-NOTATION does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-1264
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for NATIONAL-DRUG-CODE, then CLAIM-LINE-RECORD-LT.NATIONAL-DRUG-CODE is a valid National Drug Code (NDC) value' |
|
08/21/2020
|
2.4.0 |
RULE-1267
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1269
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for HCPCS-RATE, then CLAIM-LINE-RECORD-LT.HCPCS-RATE does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-1272
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-LT has a valid, non-null value for ADJUDICATION-DATE and FILE-HEADER-RECORD-LT has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE is less than or equal to FILE-HEADER-RECORD-LT.END-OF-TIME-PERIOD' |
|
08/21/2020
|
2.4.0 |
RULE-1273
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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-LINE-RECORD-LT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for ADMISSION-DATE and CLAIM-LINE-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-LINE-RECORD-LT.ADJUDICATION-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-1274
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1275
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for PRE-AUTHORIZATION-NUM, then CLAIM-LINE-RECORD-LT.PRE-AUTHORIZATION-NUM does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-1391
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT is equal to the sum of all CLAIM-LINE-RECORD-OT.BILLED-AMT values' |
|
08/21/2020
|
2.4.0 |
RULE-1393
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-ALLOWED-AMT, then CLAIM-HEADER-RECORD-OT.TOT-ALLOWED-AMT is equal to the sum of all CLAIM-LINE-RECORD-OT.ALLOWED-AMT values' |
|
08/21/2020
|
2.4.0 |
RULE-1423
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-OT.BILLING-PROV-NUM' |
|
08/21/2020
|
2.4.0 |
RULE-1430
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for CLAIM-LINE-COUNT, then CLAIM-HEADER-RECORD-OT.CLAIM-LINE-COUNT is equal to the total number of CLAIM-LINE-RECORD-OT records' |
|
08/21/2020
|
2.4.0 |
RULE-1543
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '121', '122', then CLAIM-HEADER-RECORD-OT has a null or invalid value for BILLING-PROV-NPI-NUM' |
|
08/21/2020
|
2.4.0 |
RULE-1546
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '121', '122', then CLAIM-HEADER-RECORD-OT has a null or invalid value for BILLING-PROV-TAXONOMY' |
|
08/21/2020
|
2.4.0 |
RULE-1552
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE equals '121', then CLAIM-HEADER-RECORD-OT has a null or invalid value for REFERRING-PROV-NPI-NUM' |
|
08/21/2020
|
2.4.0 |
RULE-1554
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '121', '122', then CLAIM-HEADER-RECORD-OT has a null or invalid value for REFERRING-PROV-TAXONOMY' |
|
08/21/2020
|
2.4.0 |
RULE-1560
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '121', '122', then CLAIM-HEADER-RECORD-OT has a null or invalid value for PLACE-OF-SERVICE' |
|
08/21/2020
|
2.4.0 |
RULE-1590
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE equals '121', then CLAIM-HEADER-RECORD-OT has a null or invalid value for HEALTH-HOME-PROVIDER-NPI' |
|
08/21/2020
|
2.4.0 |
RULE-1598
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE equals '121', then CLAIM-HEADER-RECORD-OT has a null or invalid value for UNDER-SUPERVISION-OF-PROV-NPI' |
|
08/21/2020
|
2.4.0 |
RULE-1609
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X' and CLAIM-LINE-RECORD-OT has a valid, non-null value for MSIS-IDENTIFICATION-NUM, then CLAIM-LINE-RECORD-OT.MSIS-IDENTIFICATION-NUM starts with the '&' symbol' |
|
08/21/2020
|
2.4.0 |
RULE-1610
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-OT has corresponding parent record CLAIM-HEADER-RECORD-OT |
|
08/21/2020
|
2.4.0 |
RULE-1615
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.LINE-ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT has a null or invalid value for LINE-NUM-ADJ' |
|
08/21/2020
|
2.4.0 |
RULE-1617
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for LINE-NUM-ADJ and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT has a valid, non-null value for LINE-ADJUSTMENT-IND' |
|
08/21/2020
|
2.4.0 |
RULE-1618
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1620
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1621
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid date of the form CCYYMMDD |
|
08/21/2020
|
2.4.0 |
RULE-1623
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE' |
|
08/21/2020
|
2.4.0 |
RULE-1624
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-1626
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and FILE-HEADER-RECORD-OT has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to FILE-HEADER-RECORD-OT.END-OF-TIME-PERIOD' |
|
08/21/2020
|
2.4.0 |
RULE-1627
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid date of the form CCYYMMDD |
|
08/21/2020
|
2.4.0 |
RULE-1630
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-1632
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and FILE-HEADER-RECORD-OT has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to FILE-HEADER-RECORD-OT.END-OF-TIME-PERIOD' |
|
08/21/2020
|
2.4.0 |
RULE-1633
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1634
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for PROCEDURE-CODE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.PROCEDURE-CODE is a valid value specified by CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG or is a state valid value from 'PROCEDURE-CODE-STATE'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '01', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'CPT'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '02', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'ICD-9-PROCEDURE-CODE'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '06', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'HCPCS'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '07', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'ICD-10-PROCEDURE-CODE'.' |
|
08/21/2020
|
2.4.0 |
RULE-1635
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid date of the form CCYYMMDD |
|
08/21/2020
|
2.4.0 |
RULE-1637
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for PROCEDURE-CODE-DATE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-DATE is less than or equal to CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE' |
|
08/21/2020
|
2.4.0 |
RULE-1638
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for PROCEDURE-CODE-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-1641
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1642
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1644
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1645
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1646
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1648
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1649
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1651
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'C', '3', 'W', then CLAIM-LINE-RECORD-OT has a valid, non-null value for MEDICAID-FFS-EQUIVALENT-AMT' |
|
08/21/2020
|
2.4.0 |
RULE-1652
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1653
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999 |
|
08/21/2020
|
2.4.0 |
RULE-1655
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1656
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '127', '131', '134', '135', '136', '137', '138', '139', '140', '141', '142', '143', '144'' |
|
08/21/2020
|
2.4.0 |
RULE-1658
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TOOTH-QUAD-CODE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '013', '029', '035'' |
|
08/21/2020
|
2.4.0 |
RULE-1659
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TOOTH-SURFACE-CODE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '013', '029', '015', '028'' |
|
08/21/2020
|
2.4.0 |
RULE-1660
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-TAXONOMY' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1662
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '121', '122' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT has a null or invalid value for SERVICING-PROV-NUM' |
|
08/21/2020
|
2.4.0 |
RULE-1663
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-OT, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV- |
|
08/21/2020
|
2.4.0 |
RULE-1664
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(10) |
|
08/21/2020
|
2.4.0 |
RULE-1665
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-OT.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
|
08/21/2020
|
2.4.0 |
RULE-1666
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '121', '122' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT has a null or invalid value for SERVICING-PROV-NPI-NUM' |
|
08/21/2020
|
2.4.0 |
RULE-1667
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE equals '121' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT has a null or invalid value for SERVICING-PROV-NPI-NUM' |
|
08/21/2020
|
2.4.0 |
RULE-1668
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2' |
|
08/21/2020
|
2.4.0 |
RULE-1669
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1670
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '121', '122' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT has a null or invalid value for SERVICING-PROV-TAXONOMY' |
|
08/21/2020
|
2.4.0 |
RULE-1671
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1672
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1673
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1674
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-DESIGNATION-SYSTEM' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1675
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-NUM' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1676
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-QUAD-CODE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1677
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-SURFACE-CODE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1678
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ORIGINATION-ADDR-LN1, then CLAIM-LINE-RECORD-OT.ORIGINATION-ADDR-LN1 does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-1679
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ORIGINATION-ADDR-LN2, then CLAIM-LINE-RECORD-OT.ORIGINATION-ADDR-LN2 does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-1680
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ORIGINATION-CITY, then CLAIM-LINE-RECORD-OT.ORIGINATION-CITY does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-1681
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1682
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ORIGINATION-ZIP-CODE, then CLAIM-LINE-RECORD-OT.ORIGINATION-ZIP-CODE is either a 5-digit or 9-digit number' |
|
08/21/2020
|
2.4.0 |
RULE-1683
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for DESTINATION-ADDR-LN1, then CLAIM-LINE-RECORD-OT.DESTINATION-ADDR-LN1 does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-1684
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for DESTINATION-ADDR-LN2, then CLAIM-LINE-RECORD-OT.DESTINATION-ADDR-LN2 does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-1685
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for DESTINATION-ADDR-LN2 and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.DESTINATION-ADDR-LN2 does not equal CLAIM-LINE-RECORD-OT.DESTINATION-ADDR-LN1' |
|
08/21/2020
|
2.4.0 |
RULE-1686
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for DESTINATION-CITY, then CLAIM-LINE-RECORD-OT.DESTINATION-CITY does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-1687
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1688
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for DESTINATION-ZIP-CODE, then CLAIM-LINE-RECORD-OT.DESTINATION-ZIP-CODE is either a 5-digit or 9-digit number' |
|
08/21/2020
|
2.4.0 |
RULE-1689
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1690
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1693
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1695
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1697
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1698
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for STATE-NOTATION, then CLAIM-LINE-RECORD-OT.STATE-NOTATION does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-1702
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for NATIONAL-DRUG-CODE, then CLAIM-LINE-RECORD-OT.NATIONAL-DRUG-CODE is a valid National Drug Code (NDC) value' |
|
08/21/2020
|
2.4.0 |
RULE-1703
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1706
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1709
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for HCPCS-RATE, then CLAIM-LINE-RECORD-OT.HCPCS-RATE does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-1712
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and FILE-HEADER-RECORD-OT has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE is less than or equal to FILE-HEADER-RECORD-OT.END-OF-TIME-PERIOD' |
|
08/21/2020
|
2.4.0 |
RULE-1713
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1714
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for PRE-AUTHORIZATION-NUM, then CLAIM-LINE-RECORD-OT.PRE-AUTHORIZATION-NUM does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-1715
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1716
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(6)V999 |
|
08/21/2020
|
2.4.0 |
RULE-1718
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1789
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT is equal to the sum of all CLAIM-LINE-RECORD-RX.BILLED-AMT values' |
|
08/21/2020
|
2.4.0 |
RULE-1791
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-ALLOWED-AMT, then CLAIM-HEADER-RECORD-RX.TOT-ALLOWED-AMT is equal to the sum of all CLAIM-LINE-RECORD-RX.ALLOWED-AMT values' |
|
08/21/2020
|
2.4.0 |
RULE-1796
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT, then CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT is equal to the sum of all CLAIM-LINE-RECORD-RX.MEDICARE-DEDUCTIBLE-AMT values', where CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
|
08/21/2020
|
2.4.0 |
RULE-1826
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for CLAIM-LINE-COUNT, then CLAIM-HEADER-RECORD-RX.CLAIM-LINE-COUNT is equal to the total number of CLAIM-LINE-RECORD-RX records' |
|
08/21/2020
|
2.4.0 |
RULE-1908
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X' and CLAIM-LINE-RECORD-RX has a valid, non-null value for MSIS-IDENTIFICATION-NUM, then CLAIM-LINE-RECORD-RX.MSIS-IDENTIFICATION-NUM starts with the '&' symbol' |
|
08/21/2020
|
2.4.0 |
RULE-1909
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-RX has corresponding parent record CLAIM-HEADER-RECORD-RX |
|
08/21/2020
|
2.4.0 |
RULE-1914
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX has a null or invalid value for LINE-NUM-ADJ' |
|
08/21/2020
|
2.4.0 |
RULE-1917
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for LINE-NUM-ADJ and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX has a valid, non-null value for LINE-ADJUSTMENT-IND' |
|
08/21/2020
|
2.4.0 |
RULE-1920
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1921
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for NATIONAL-DRUG-CODE, then CLAIM-LINE-RECORD-RX.NATIONAL-DRUG-CODE is a valid National Drug Code (NDC) value' |
|
08/21/2020
|
2.4.0 |
RULE-1924
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1925
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1926
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(5)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1927
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1928
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1929
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1930
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'C', '3', 'W', then CLAIM-LINE-RECORD-RX has a valid, non-null value for MEDICAID-FFS-EQUIVALENT-AMT' |
|
08/21/2020
|
2.4.0 |
RULE-1931
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1932
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1933
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1934
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999 |
|
08/21/2020
|
2.4.0 |
RULE-1935
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999 |
|
08/21/2020
|
2.4.0 |
RULE-1936
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'UNIT-OF-MEASURE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1937
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1938
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '011', '018', '033', '034', '036', '085', '089', '127', '131', '136', '137'' |
|
08/21/2020
|
2.4.0 |
RULE-1940
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-SERVICE-CODE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1941
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-TAXONOMY' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1942
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1943
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for DAYS-SUPPLY, then CLAIM-LINE-RECORD-RX.DAYS-SUPPLY is greater than or equal to -365 AND less than or equal to 365' |
|
08/21/2020
|
2.4.0 |
RULE-1944
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NEW-REFILL-IND' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1945
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BRAND-GENERIC-IND' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1946
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1947
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for PRESCRIPTION-NUM, then CLAIM-LINE-RECORD-RX.PRESCRIPTION-NUM does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-1948
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z', then The substring CLAIM-LINE-RECORD-RX.DRUG-UTILIZATION-CODE(0, 2) must be contained in the set of valid values with id: 'DRUG-UTILIZATION-CODE-E4'' |
|
08/21/2020
|
2.4.0 |
RULE-1949
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(7)V999 |
|
08/21/2020
|
2.4.0 |
RULE-1950
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'COMPOUND-DOSAGE-FORM' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1951
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REBATE-ELIGIBLE-INDICATOR' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1952
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1953
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1954
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1957
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1959
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1960
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-1961
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for STATE-NOTATION, then CLAIM-LINE-RECORD-RX.STATE-NOTATION does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-1967
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-RX has a valid, non-null value for ADJUDICATION-DATE and FILE-HEADER-RECORD-RX has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.ADJUDICATION-DATE is less than or equal to FILE-HEADER-RECORD-RX.END-OF-TIME-PERIOD' |
|
08/21/2020
|
2.4.0 |
RULE-1968
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-1969
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for PRE-AUTHORIZATION-NUM, then CLAIM-LINE-RECORD-RX.PRE-AUTHORIZATION-NUM does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-2758
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DATE-OF-BIRTH and the first character of CLAIM-LINE-RECORD-OT.TOOTH-NUM is one of 'A' through 'T', then the difference between dates CLAIM-HEADER-RECORD-OT.DATE-OF-BIRTH and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is less than 15 years' |
|
08/21/2020
|
2.4.0 |
RULE-423
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-1, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-1' |
|
08/21/2020
|
2.4.0 |
RULE-436
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-2 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-2' |
|
08/21/2020
|
2.4.0 |
RULE-449
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-3 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-3' |
|
08/21/2020
|
2.4.0 |
RULE-463
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-4 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-4' |
|
08/21/2020
|
2.4.0 |
RULE-476
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-5 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-5' |
|
08/21/2020
|
2.4.0 |
RULE-488
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-6 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-6' |
|
08/21/2020
|
2.4.0 |
RULE-534
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-ALLOWED-AMT, then CLAIM-HEADER-RECORD-IP.TOT-ALLOWED-AMT is equal to the sum of all CLAIM-LINE-RECORD-IP.ALLOWED-AMT values' |
|
08/21/2020
|
2.4.0 |
RULE-577
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for CLAIM-LINE-COUNT, then CLAIM-HEADER-RECORD-IP.CLAIM-LINE-COUNT is equal to the total number of CLAIM-LINE-RECORD-IP records' |
|
08/21/2020
|
2.4.0 |
RULE-6074
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.ORIGINATION-ADDR-LN1 does not equal CLAIM-LINE-RECORD-OT.ORIGINATION-ADDR-LN2' |
|
08/21/2020
|
2.4.0 |
RULE-6112
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(10) |
|
08/21/2020
|
2.4.0 |
RULE-6132
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6133
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6152
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4) |
|
08/21/2020
|
2.4.0 |
RULE-6159
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1) |
|
08/21/2020
|
2.4.0 |
RULE-6164
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6166
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6173
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6175
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12) |
|
08/21/2020
|
2.4.0 |
RULE-6177
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(9) |
|
08/21/2020
|
2.4.0 |
RULE-6179
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6183
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999 |
|
08/21/2020
|
2.4.0 |
RULE-6187
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(5) |
|
08/21/2020
|
2.4.0 |
RULE-6192
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(18) |
|
08/21/2020
|
2.4.0 |
RULE-6194
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6204
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(30) |
|
08/21/2020
|
2.4.0 |
RULE-6216
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(20) |
|
08/21/2020
|
2.4.0 |
RULE-6219
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1) |
|
08/21/2020
|
2.4.0 |
RULE-6220
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6238
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(20) |
|
08/21/2020
|
2.4.0 |
RULE-6239
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12) |
|
08/21/2020
|
2.4.0 |
RULE-6257
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12) |
|
08/21/2020
|
2.4.0 |
RULE-6264
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6277
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6316
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6318
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(8) |
|
08/21/2020
|
2.4.0 |
RULE-6328
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6334
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6336
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(14) |
|
08/21/2020
|
2.4.0 |
RULE-6346
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12) |
|
08/21/2020
|
2.4.0 |
RULE-6347
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6349
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(18) |
|
08/21/2020
|
2.4.0 |
RULE-6354
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4) |
|
08/21/2020
|
2.4.0 |
RULE-6363
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6364
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(30) |
|
08/21/2020
|
2.4.0 |
RULE-6371
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(28) |
|
08/21/2020
|
2.4.0 |
RULE-6372
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6373
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6375
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6377
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6378
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1) |
|
08/21/2020
|
2.4.0 |
RULE-6386
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6387
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6363
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6364
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(30) |
|
08/21/2020
|
2.4.0 |
RULE-6371
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(28) |
|
08/21/2020
|
2.4.0 |
RULE-6372
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6373
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6375
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6377
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6378
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1) |
|
08/21/2020
|
2.4.0 |
RULE-6386
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6387
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6408
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6421
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(500) |
|
08/21/2020
|
2.4.0 |
RULE-6425
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6426
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6431
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6435
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6436
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6451
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12) |
|
08/21/2020
|
2.4.0 |
RULE-6461
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1) |
|
08/21/2020
|
2.4.0 |
RULE-6463
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(5) |
|
08/21/2020
|
2.4.0 |
RULE-6482
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6489
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(8) |
|
08/21/2020
|
2.4.0 |
RULE-6493
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: 9(11) |
|
08/21/2020
|
2.4.0 |
RULE-6495
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1) |
|
08/21/2020
|
2.4.0 |
RULE-6496
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6510
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12) |
|
08/21/2020
|
2.4.0 |
RULE-6544
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6565
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6566
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6579
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6589
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6605
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12) |
|
08/21/2020
|
2.4.0 |
RULE-6606
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6609
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(60) |
|
08/21/2020
|
2.4.0 |
RULE-6611
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(18) |
|
08/21/2020
|
2.4.0 |
RULE-6615
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(60) |
|
08/21/2020
|
2.4.0 |
RULE-6623
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1) |
|
08/21/2020
|
2.4.0 |
RULE-6628
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(500) |
|
08/21/2020
|
2.4.0 |
RULE-6630
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4) |
|
08/21/2020
|
2.4.0 |
RULE-6633
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-6638
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(20) |
|
08/21/2020
|
2.4.0 |
RULE-6642
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6651
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: 9(11) |
|
08/21/2020
|
2.4.0 |
RULE-6654
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6659
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(28) |
|
08/21/2020
|
2.4.0 |
RULE-6661
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(6)V999 |
|
08/21/2020
|
2.4.0 |
RULE-6665
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6689
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6703
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4) |
|
08/21/2020
|
2.4.0 |
RULE-6707
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12) |
|
08/21/2020
|
2.4.0 |
RULE-6716
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6720
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6726
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(9) |
|
08/21/2020
|
2.4.0 |
RULE-6730
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6732
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(500) |
|
08/21/2020
|
2.4.0 |
RULE-6734
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6740
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6741
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(500) |
|
08/21/2020
|
2.4.0 |
RULE-6744
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(8) |
|
08/21/2020
|
2.4.0 |
RULE-6784
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6799
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(10) |
|
08/21/2020
|
2.4.0 |
RULE-6800
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(18) |
|
08/21/2020
|
2.4.0 |
RULE-6804
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6827
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6830
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: 9(11) |
|
08/21/2020
|
2.4.0 |
RULE-6853
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(20) |
|
08/21/2020
|
2.4.0 |
RULE-6857
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(5) |
|
08/21/2020
|
2.4.0 |
RULE-6862
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1) |
|
08/21/2020
|
2.4.0 |
RULE-6880
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6898
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(9) |
|
08/21/2020
|
2.4.0 |
RULE-6901
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4) |
|
08/21/2020
|
2.4.0 |
RULE-6925
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1) |
|
08/21/2020
|
2.4.0 |
RULE-6935
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4) |
|
08/21/2020
|
2.4.0 |
RULE-6947
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6952
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-6953
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12) |
|
08/21/2020
|
2.4.0 |
RULE-6957
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(60) |
|
08/21/2020
|
2.4.0 |
RULE-6958
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(60) |
|
08/21/2020
|
2.4.0 |
RULE-6979
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-6983
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-7002
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(14) |
|
08/21/2020
|
2.4.0 |
RULE-7012
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-7019
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(1) |
|
08/21/2020
|
2.4.0 |
RULE-7020
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-7024
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-7027
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4) |
|
08/21/2020
|
2.4.0 |
RULE-7031
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: 9(11) |
|
08/21/2020
|
2.4.0 |
RULE-7038
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-7047
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-7049
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(6) |
|
08/21/2020
|
2.4.0 |
RULE-7059
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12) |
|
08/21/2020
|
2.4.0 |
RULE-7060
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12) |
|
08/21/2020
|
2.4.0 |
RULE-7062
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12) |
|
08/21/2020
|
2.4.0 |
RULE-7065
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(3) |
|
08/21/2020
|
2.4.0 |
RULE-7069
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-7077
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(14) |
|
08/21/2020
|
2.4.0 |
RULE-7087
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(9) |
|
08/21/2020
|
2.4.0 |
RULE-7098
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(8) |
|
08/21/2020
|
2.4.0 |
RULE-7115
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(2) |
|
08/21/2020
|
2.4.0 |
RULE-7122
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-7123
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(30) |
|
08/21/2020
|
2.4.0 |
RULE-7124
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(8) |
|
08/21/2020
|
2.4.0 |
RULE-7134
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-SERVICE-CODE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-7202
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z', then The substring CLAIM-LINE-RECORD-RX.DRUG-UTILIZATION-CODE(2, 2) must be contained in the set of valid values with id: 'DRUG-UTILIZATION-CODE-E5'' |
|
08/21/2020
|
2.4.0 |
RULE-7203
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z', then The substring CLAIM-LINE-RECORD-RX.DRUG-UTILIZATION-CODE(4, 2) must be contained in the set of valid values with id: 'DRUG-UTILIZATION-CODE-E6'' |
|
08/21/2020
|
2.4.0 |
RULE-7209
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
08/21/2020
|
2.4.0 |
RULE-7210
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
08/21/2020
|
2.4.0 |
RULE-7217
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
08/21/2020
|
2.4.0 |
RULE-7218
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
08/21/2020
|
2.4.0 |
RULE-7252
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
08/21/2020
|
2.4.0 |
RULE-7253
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
08/21/2020
|
2.4.0 |
RULE-7258
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-IP has a non-null value for TYPE-OF-SERVICE' |
|
08/21/2020
|
2.4.0 |
RULE-7259
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-LT has a non-null value for TYPE-OF-SERVICE' |
|
08/21/2020
|
2.4.0 |
RULE-7260
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-OT has a non-null value for TYPE-OF-SERVICE' |
|
08/21/2020
|
2.4.0 |
RULE-7261
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-RX has a non-null value for TYPE-OF-SERVICE' |
|
08/21/2020
|
2.4.0 |
RULE-7262
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-IP has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
|
08/21/2020
|
2.4.0 |
RULE-7263
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-LT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
|
08/21/2020
|
2.4.0 |
RULE-7264
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
|
08/21/2020
|
2.4.0 |
RULE-7265
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-RX has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
|
08/21/2020
|
2.4.0 |
RULE-7273
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0' and (CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' or CLAIM-HEADER-RECORD-OT has a null value for CROSSOVER-INDICATOR), then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for MEDICAID-PAID-AMT' |
|
08/21/2020
|
2.4.0 |
RULE-7278
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND equals '0', then CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-IP.MEDICAID-PAID-AMT values', where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
|
08/21/2020
|
2.4.0 |
RULE-7279
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND equals '0', then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT values', where CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
|
08/21/2020
|
2.4.0 |
RULE-7280
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0', then CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT values', where CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
|
08/21/2020
|
2.4.0 |
RULE-7281
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0', then CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-RX.MEDICAID-PAID-AMT values', where CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
|
08/21/2020
|
2.4.0 |
RULE-7285
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', '1' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-OT.PAYMENT-LEVEL-IND equals '2' and CLAIM-LINE-RECORD-OT has a non-null value for MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-OT.ALLOWED-AMT does not equal '0.00' and CLAIM-LINE-RECORD-OT has a non-null value for ALLOWED-AMT, then CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT is less than or equal to CLAIM-LINE-RECORD-OT.ALLOWED-AMT' |
|
08/21/2020
|
2.4.0 |
RULE-7293
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE-FLAG, then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE' |
|
08/21/2020
|
2.4.0 |
RULE-7294
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE, then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE-FLAG' |
|
08/21/2020
|
2.4.0 |
RULE-7295
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '138', '139', '140', '141', '142', '143', '144' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B'' |
|
08/21/2020
|
2.4.0 |
RULE-7296
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE equals '138', then CLAIM-HEADER-RECORD-OT has a non-null value for HEALTH-HOME-ENTITY-NAME' |
|
08/21/2020
|
2.4.0 |
RULE-7300
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-OT.XIX-MBESCBES-CATEGORY-OF-SERVICE equals '45' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686', then CLAIM-HEADER-RECORD-OT has a non-null value for HEALTH-HOME-ENTITY-NAME' |
|
08/21/2020
|
2.4.0 |
RULE-7309
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NPI-NUM' |
|
08/21/2020
|
2.4.0 |
RULE-7310
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NPI-NUM' |
|
08/21/2020
|
2.4.0 |
RULE-7311
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NPI-NUM' |
|
08/21/2020
|
2.4.0 |
RULE-767
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X', then CLAIM-LINE-RECORD-IP.MSIS-IDENTIFICATION-NUM starts with the '&' symbol' |
|
08/21/2020
|
2.4.0 |
RULE-768
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-IP has corresponding parent record CLAIM-HEADER-RECORD-IP |
|
08/21/2020
|
2.4.0 |
RULE-775
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for LINE-NUM-ADJ and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP has a valid, non-null value for LINE-ADJUSTMENT-IND' |
|
08/21/2020
|
2.4.0 |
RULE-776
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-778
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-779
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid date of the form CCYYMMDD |
|
08/21/2020
|
2.4.0 |
RULE-781
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and FILE-HEADER-RECORD-IP has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to FILE-HEADER-RECORD-IP.END-OF-TIME-PERIOD' |
|
08/21/2020
|
2.4.0 |
RULE-782
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE' |
|
08/21/2020
|
2.4.0 |
RULE-783
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-IP has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-786
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid date of the form CCYYMMDD |
|
08/21/2020
|
2.4.0 |
RULE-789
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-IP has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-791
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE and FILE-HEADER-RECORD-IP has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is less than or equal to FILE-HEADER-RECORD-IP.END-OF-TIME-PERIOD' |
|
08/21/2020
|
2.4.0 |
RULE-792
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-793
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-794
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(6)V999 |
|
08/21/2020
|
2.4.0 |
RULE-795
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(6)V999 |
|
08/21/2020
|
2.4.0 |
RULE-796
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-797
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT is greater than or equal to the sum of all CLAIM-LINE-RECORD-IP.REVENUE-CHARGE values' |
|
08/21/2020
|
2.4.0 |
RULE-798
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP has a valid, non-null value for REVENUE-CODE, then CLAIM-LINE-RECORD-IP has a valid, non-null value for REVENUE-CHARGE' |
|
08/21/2020
|
2.4.0 |
RULE-800
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-801
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-802
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-803
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-804
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: 'C', '3', 'W', then CLAIM-LINE-RECORD-IP has a valid, non-null value for MEDICAID-FFS-EQUIVALENT-AMT' |
|
08/21/2020
|
2.4.0 |
RULE-805
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BILLING-UNIT' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-806
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-807
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '001', '058', '060', '084', '086', '090', '091', '092', '093', '123', '132', '135', '136', '137'' |
|
08/21/2020
|
2.4.0 |
RULE-810
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-IP, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV- |
|
08/21/2020
|
2.4.0 |
RULE-812
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-IP.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
|
08/21/2020
|
2.4.0 |
RULE-814
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-815
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-816
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-817
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for OPERATING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-IP.OPERATING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
|
08/21/2020
|
2.4.0 |
RULE-819
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP has a valid, non-null value for OPERATING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2' |
|
08/21/2020
|
2.4.0 |
RULE-820
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-821
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-FACILITY-TYPE' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-822
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-823
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-826
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-828
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-829
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
08/21/2020
|
2.4.0 |
RULE-830
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for STATE-NOTATION, then CLAIM-LINE-RECORD-IP.STATE-NOTATION does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-832
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(6)V999 |
|
08/21/2020
|
2.4.0 |
RULE-833
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for HCPCS-RATE, then CLAIM-LINE-RECORD-IP.HCPCS-RATE does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-834
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for NATIONAL-DRUG-CODE, then CLAIM-LINE-RECORD-IP.NATIONAL-DRUG-CODE is a valid National Drug Code (NDC) value' |
|
08/21/2020
|
2.4.0 |
RULE-837
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-840
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-IP has a valid, non-null value for ADJUDICATION-DATE and FILE-HEADER-RECORD-IP has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE is less than or equal to FILE-HEADER-RECORD-IP.END-OF-TIME-PERIOD' |
|
08/21/2020
|
2.4.0 |
RULE-841
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: '2', 'B', 'V' and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for ADMISSION-DATE and CLAIM-LINE-RECORD-IP has a valid, non-null value for ADJUDICATION-DATE, then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is less than or equal to CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-842
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
08/21/2020
|
2.4.0 |
RULE-843
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for PRE-AUTHORIZATION-NUM, then CLAIM-LINE-RECORD-IP.PRE-AUTHORIZATION-NUM does not contain any pipe (|) or asterisk (*) characters' |
|
08/21/2020
|
2.4.0 |
RULE-973
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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' |
|
08/21/2020
|
2.4.0 |
RULE-1964
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE, PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that |
|
08/21/2020
|
2.4.0 |
RULE-1939
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE does not equal '086'' |
|
08/21/2020
|
2.4.0 |
RULE-1955
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'' |
|
08/21/2020
|
2.4.0 |
RULE-1958
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-RX.XIX-MBESCBES-CATEGORY-OF-SERVICE is not equal to one of the following: '14', '35', '42', '44'' |
|
08/21/2020
|
2.4.0 |
RULE-7206
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'' |
|
08/21/2020
|
2.4.0 |
RULE-1221
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-LINE-RECORD-LT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
|
08/21/2020
|
2.4.0 |
RULE-1226
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-LINE-RECORD-LT has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
|
08/21/2020
|
2.4.0 |
RULE-1256
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'' |
|
08/21/2020
|
2.4.0 |
RULE-1260
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-LT.XIX-MBESCBES-CATEGORY-OF-SERVICE is not equal to one of the following: '14', '35', '42', '44'' |
|
08/21/2020
|
2.4.0 |
RULE-1625
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
|
08/21/2020
|
2.4.0 |
RULE-1631
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
|
08/21/2020
|
2.4.0 |
RULE-1639
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-LINE-RECORD-OT has a valid, non-null value for PROCEDURE-CODE-DATE, then CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
|
08/21/2020
|
2.4.0 |
RULE-1657
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '025', '085'' |
|
08/21/2020
|
2.4.0 |
RULE-1691
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'' |
|
08/21/2020
|
2.4.0 |
RULE-1694
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-OT.XIX-MBESCBES-CATEGORY-OF-SERVICE is not equal to one of the following: '14', '35', '42', '44'' |
|
08/21/2020
|
2.4.0 |
RULE-519
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '00' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then CLAIM-HEADER-RECORD-IP.ALLOWED-CHARGE-SRC is not equal to one of the following: '1', 'I', 'K', 'M'' |
|
08/21/2020
|
2.4.0 |
RULE-7204
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'' |
|
08/21/2020
|
2.4.0 |
RULE-7205
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'' |
|
08/21/2020
|
2.4.0 |
RULE-7207
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'' |
|
08/21/2020
|
2.4.0 |
RULE-784
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
|
08/21/2020
|
2.4.0 |
RULE-790
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
|
08/21/2020
|
2.4.0 |
RULE-808
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE does not equal '086'' |
|
08/21/2020
|
2.4.0 |
RULE-824
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'' |
|
08/21/2020
|
2.4.0 |
RULE-827
|
UPDATE |
Data Dictionary - Validation Rules |
Rule only triggered on adjustment claim lines, not on original claims. |
Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-IP.XIX-MBESCBES-CATEGORY-OF-SERVICE is not equal to one of the following: '14', '35', '42', '44'' |
|
05/24/2019
|
2.3.0 |
RULE-978
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT is less than or equal to CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT' |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT is greater than zero and CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT is less than or equal to CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT |
|
05/24/2019
|
2.3.0 |
RULE-539
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT is less than or equal to CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT' |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT is greater than zero and CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT is less than or equal to CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT |
|
05/24/2019
|
2.3.0 |
RULE-1795
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT is less than or equal to CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT' |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT is greater than zero and CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT is less than or equal to CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT |
|
05/24/2019
|
2.3.0 |
RULE-1397
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT is less than or equal to CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT' |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT is greater than zero and CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT is less than or equal to CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT |
|
05/24/2019
|
2.3.0 |
RULE-982
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is greater than zero or CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is less than CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT' |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is greater than zero and CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is less than or equal to CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT' |
|
05/24/2019
|
2.3.0 |
RULE-543
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT is greater than zero or CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT is less than CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT' |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT is greater than zero and CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT is less than or equal to CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT' |
|
05/24/2019
|
2.3.0 |
RULE-1798
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT is less than CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT' |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-RX has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT is greater than zero and CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT is less than or equal to CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT' |
|
05/24/2019
|
2.3.0 |
RULE-1401
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT is less than CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT' |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT is greater than zero and CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT is less than or equal to CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT' |
|
07/19/2019
|
2.3.0 |
RULE-1004
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-LT has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM' |
N/A |
|
07/19/2019
|
2.3.0 |
RULE-1014
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for MEDICAID-COV-INPATIENT-DAYS 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 DISCHARGE-DATE, then CLAIM-HEADER-RECORD-LT.MEDICAID-COV-INPATIENT-DAYS is less than or equal to double the number of days between between CLAIM-HEADER-RECORD-LT.ADMISSION-DATE and CLAIM-HEADER-RECORD-LT.DISCHARGE-DATE, plus one day' |
N/A |
|
10/02/2020
|
2.4.0 |
RULE-1485
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for OCCURRENCE-CODE-01,
then CLAIM-HEADER-RECORD-OT has a valid, non-null value for OCCURRENCE-CODE-END-DATE-01' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal ‘F2'
and CLAIM-HEADER-RECORD-OT has a non-null value for OCCURRENCE-CODE-01
and CLAIM-HEADER-RECORD-OT.OCCURRENCE-CODE-01 in (’70', ‘71’, ‘72’, ‘73’, ‘74’, ‘75’, ‘76’, ‘77’, ‘78’, ‘79’, ‘80’, ‘81’, ‘99’, 'M0', ‘M1’, ‘M2’, ‘M3’, ‘M4’, ‘ZZ’)
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for OCCURRENCE-CODE-END-DATE-01' |
|
01/31/2020
|
2.4.0 |
RULE-1543
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '121', '122', then CLAIM-HEADER-RECORD-OT has a null or invalid value for BILLING-PROV-NPI-NUM' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '121', '122', then CLAIM-HEADER-RECORD-OT has a null or invalid value for BILLING-PROV-NPI-NUM' |
|
07/19/2019
|
2.3.0 |
RULE-1819
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM' |
N/A |
|
01/31/2020
|
2.4.0 |
RULE-2017
|
UPDATE |
Data Dictionary - Validation Rules |
if ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64', then the difference between dates PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-BIRTH and FILE-HEADER-RECORD-ELIGIBILITY.START-OF-TIME-PERIOD is less than or equal to 125 years' |
if ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-BIRTH and ENROLLMENT-TIME-SPAN-SEGMENT has a valid, non-null value for ENROLLMENT-EFF-DATE, then the difference between dates PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-BIRTH and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE is less than or equal to 125 years' |
|
07/19/2019
|
2.3.0 |
RULE-2056
|
UPDATE |
Data Dictionary - Validation Rules |
'if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.IMMIGRATION-STATUS is equal to one of the following: '1', '2', '3', then VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for IMMIGRATION-STATUS-FIVE-YEAR-BAR-END-DATE' |
N/A |
|
07/19/2019
|
2.3.0 |
RULE-544
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-MEDICARE-COINS-AMT' |
N/A |
|
07/19/2019
|
2.3.0 |
RULE-564
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM' |
N/A |
|
07/19/2019
|
2.3.0 |
RULE-572
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for NON-COV-DAYS and CLAIM-HEADER-RECORD-IP has a valid, non-null value for MEDICAID-COV-INPATIENT-DAYS, then the sum of CLAIM-HEADER-RECORD-IP.NON-COV-DAYS and CLAIM-HEADER-RECORD-IP.MEDICAID-COV-INPATIENT-DAYS is less than or equal to the number of days between the earliest CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE date and the latest CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE date plus one day', where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS does not equal '585' |
N/A |
|
07/19/2019
|
2.3.0 |
RULE-2021
|
UPDATE |
Data Dictionary - Validation Rules |
'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and FILE-HEADER-RECORD-ELIGIBILITY has a valid, non-null value for END-OF-TIME-PERIOD, then PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH is less than or equal to FILE-HEADER-RECORD-ELIGIBILITY.END-OF-TIME-PERIOD' |
N/A |
|
07/19/2019
|
2.3.0 |
RULE-2195
|
UPDATE |
Data Dictionary - Validation Rules |
'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and HEALTH-HOME-SPA-PARTICIPATION-INFORMATION has a valid, non-null value for HEALTH-HOME-SPA-PARTICIPATION-END-DATE, then HEALTH-HOME-SPA-PARTICIPATION-INFORMATION.HEALTH-HOME-SPA-PARTICIPATION-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
N/A |
|
07/19/2019
|
2.3.0 |
RULE-2268
|
UPDATE |
Data Dictionary - Validation Rules |
'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and LOCK-IN-INFORMATION has a valid, non-null value for LOCKIN-END-DATE, then LOCK-IN-INFORMATION.LOCKIN-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
N/A |
|
07/19/2019
|
2.3.0 |
RULE-2295
|
UPDATE |
Data Dictionary - Validation Rules |
'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and MFP-INFORMATION has a valid, non-null value for MFP-ENROLLMENT-END-DATE, then MFP-INFORMATION.MFP-ENROLLMENT-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
N/A |
|
07/19/2019
|
2.3.0 |
RULE-2318
|
UPDATE |
Data Dictionary - Validation Rules |
'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and STATE-PLAN-OPTION-PARTICIPATION has a valid, non-null value for STATE-PLAN-OPTION-END-DATE, then STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
N/A |
|
07/19/2019
|
2.3.0 |
RULE-2343
|
UPDATE |
Data Dictionary - Validation Rules |
'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and WAIVER-PARTICIPATION has a valid, non-null value for WAIVER-ENROLLMENT-END-DATE, then WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
N/A |
|
07/19/2019
|
2.3.0 |
RULE-2366
|
UPDATE |
Data Dictionary - Validation Rules |
'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and LTSS-PARTICIPATION has a valid, non-null value for LTSS-ELIGIBILITY-END-DATE, then LTSS-PARTICIPATION.LTSS-ELIGIBILITY-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
N/A |
|
07/19/2019
|
2.3.0 |
RULE-2397
|
UPDATE |
Data Dictionary - Validation Rules |
'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and MANAGED-CARE-PARTICIPATION has a valid, non-null value for MANAGED-CARE-PLAN-ENROLLMENT-END-DATE, then MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
N/A |
|
07/19/2019
|
2.3.0 |
RULE-2483
|
UPDATE |
Data Dictionary - Validation Rules |
'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and 1115A-DEMONSTRATION-INFORMATION has a valid, non-null value for 1115A-END-DATE, then 1115A-DEMONSTRATION-INFORMATION.1115A-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
N/A |
|
08/16/2019
|
2.3.0 |
RULE-1115
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT has a valid, non-null value for DATE-OF-BIRTH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-HEADER-RECORD-LT.DATE-OF-BIRTH is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
N/A |
|
08/16/2019
|
2.3.0 |
RULE-1142
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH is less than or equal to CLAIM-HEADER-RECORD-LT.DISCHARGE-DATE, then CLAIM-HEADER-RECORD-LT.PATIENT-STATUS is equal to one of the following: '20', '40', '41', '42'' |
N/A |
|
08/16/2019
|
2.3.0 |
RULE-1529
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT has a valid, non-null value for DATE-OF-BIRTH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-HEADER-RECORD-OT.DATE-OF-BIRTH is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
N/A |
|
08/16/2019
|
2.3.0 |
RULE-1530
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT has a valid, non-null value for DATE-OF-BIRTH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-BIRTH and ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-HEADER-RECORD-OT.DATE-OF-BIRTH equals PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-BIRTH' |
N/A |
|
08/16/2019
|
2.3.0 |
RULE-1834
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX has a valid, non-null value for DATE-OF-BIRTH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-HEADER-RECORD-RX.DATE-OF-BIRTH is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
N/A |
|
08/16/2019
|
2.3.0 |
RULE-1835
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX has a valid, non-null value for DATE-OF-BIRTH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-BIRTH and ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-HEADER-RECORD-RX.DATE-OF-BIRTH equals PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-BIRTH' |
N/A |
|
08/16/2019
|
2.3.0 |
RULE-2308
|
UPDATE |
Data Dictionary - Validation Rules |
'if ELIGIBILITY-DETERMINANTS.MAINTENANCE-ASSISTANCE-STATUS equals '0' and ELIGIBILITY-DETERMINANTS.MEDICAID-BASIS-OF-ELIGIBILITY equals '00', then STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-TYPE equals '00'' |
N/A |
|
08/16/2019
|
2.3.0 |
RULE-678
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP has a valid, non-null value for DATE-OF-BIRTH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-BIRTH and ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-HEADER-RECORD-IP.DATE-OF-BIRTH equals PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-BIRTH' |
N/A |
|
08/30/2019
|
2.3.0 |
RULE-1561
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: S9(5)V9' |
N/A |
|
08/16/2019
|
2.3.0 |
RULE-7210
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', then CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE' |
|
08/16/2019
|
2.3.0 |
RULE-7209
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', then CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE' |
|
08/16/2019
|
2.3.0 |
RULE-7208
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', then CLAIM-HEADER-RECORD-IP has a valid, non-null value for ADMISSION-DATE' |
|
08/16/2019
|
2.3.0 |
RULE-7213
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1', then CLAIM-HEADER-RECORD-LT has a valid, non-null value for ENDING-DATE-OF-SERVICE' |
|
08/16/2019
|
2.3.0 |
RULE-7212
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1', then CLAIM-HEADER-RECORD-LT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE' |
|
08/16/2019
|
2.3.0 |
RULE-7214
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1', then CLAIM-HEADER-RECORD-RX has a valid, non-null value for PRESCRIPTION-FILL-DATE' |
|
08/16/2019
|
2.3.0 |
RULE-7218
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1', then CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE' |
|
08/16/2019
|
2.3.0 |
RULE-7217
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1', then CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE' |
|
08/16/2019
|
2.3.0 |
RULE-7216
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1', then CLAIM-HEADER-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE' |
|
08/16/2019
|
2.3.0 |
RULE-7215
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1', then CLAIM-HEADER-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE' |
|
08/16/2019
|
2.3.0 |
RULE-7211
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.PATIENT-STATUS does not equal '30', then CLAIM-HEADER-RECORD-IP has a valid, non-null value for DISCHARGE-DATE' |
|
11/06/2018
|
2.3.0 |
RULE-483
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-6, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-6' |
N/A |
|
11/06/2018
|
2.3.0 |
RULE-470
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-5, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-5' |
N/A |
|
11/06/2018
|
2.3.0 |
RULE-456
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-4, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-4' |
N/A |
|
11/06/2018
|
2.3.0 |
RULE-443
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-3, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-3' |
N/A |
|
11/06/2018
|
2.3.0 |
RULE-430
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-2, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-2' |
N/A |
|
11/06/2018
|
2.3.0 |
RULE-417
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-1, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-1' |
N/A |
|
11/22/2019
|
2.3.0 |
RULE-3060
|
UPDATE |
Data Dictionary - Validation Rules |
record TPL-MEDICAID-ELIGIBLE-PERSON-MAIN has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
N/A |
|
12/13/2019
|
2.3.0 |
RULE-7191
|
UPDATE |
Data Dictionary - Validation Rules |
IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "1" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be in ("1","2")
For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE and VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE <= ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE |
IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "1" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be in ("1","2")
For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE |
|
12/13/2019
|
2.3.0 |
RULE-7192
|
UPDATE |
Data Dictionary - Validation Rules |
if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '2', then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE) must be in (ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE, ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE), where VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '3' |
IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "2" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be in ("3")
For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE |
|
06/19/2020
|
2.4.0 |
RULE-7300
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-LINE-RECORD-OT.XIX-MBESCBES-CATEGORY-OF-SERVICE is equal to '45'
AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
then CLAIM-HEADER-RECORD-OT has a non-null value for 'HEALTH-HOME-ENTITY-NAME' |
|
09/11/2020
|
2.4.0 |
RULE-7366
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM
then PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null and not invalidly formatted value for DATE-OF-BIRTH |
|
09/11/2020
|
2.4.0 |
RULE-7367
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM
then PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null value for SEX. |
|
09/11/2020
|
2.4.0 |
RULE-7368
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBLE-CONTACT-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM
then ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-COUNTY-CODE |
|
09/11/2020
|
2.4.0 |
RULE-7369
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBLE-CONTACT-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM
then ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-ZIP-CODE |
|
03/27/2020
|
2.4.0 |
RULE-7243
|
ADD |
Data Dictionary - Validation Rules |
N/A |
“If PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.RECORD-ID equals ‘ELG00002’, then PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002 has a non-null value for MSIS-IDENTIFICATION-NUM.” |
|
03/27/2020
|
2.4.0 |
RULE-7244
|
ADD |
Data Dictionary - Validation Rules |
N/A |
“If VARIABLE-DEMOGRAPHICS-ELIGIBILITY-ELG00003.RECORD-ID equals ‘ELG00003’, then VARIABLE-DEMOGRAPHICS-ELIGIBILITY-ELG00003 has a non-null value for MSIS-IDENTIFICATION-NUM.” |
|
03/27/2020
|
2.4.0 |
RULE-7245
|
ADD |
Data Dictionary - Validation Rules |
N/A |
“If ELIGIBLE-CONTACT-INFORMATION-ELG00004.RECORD-ID equals ‘ELG00004’, then ELIGIBLE-CONTACT-INFORMATION-ELG00004 has a non-null value for MSIS-IDENTIFICATION-NUM.” |
|
03/27/2020
|
2.4.0 |
RULE-7246
|
ADD |
Data Dictionary - Validation Rules |
N/A |
“If ELIGIBILITY-DETERMINANTS-ELG00005.RECORD-ID equals ‘ELG00005’, then ELIGIBILITY-DETERMINANTS-ELG00005 has a non-null value for MSIS-IDENTIFICATION-NUM.” |
|
03/27/2020
|
2.4.0 |
RULE-7247
|
ADD |
Data Dictionary - Validation Rules |
N/A |
“If ENROLLMENT-TIME-SPAN-ELG00021.RECORD-ID equals ‘ELG00021’, then ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM.” |
|
03/27/2020
|
2.4.0 |
RULE-7248
|
ADD |
Data Dictionary - Validation Rules |
N/A |
“If WAIVER-PARTICIPATION-ELG00012.RECORD-ID equals ‘ELG00012’, then WAIVER-PARTICIPATION-ELG00012 has a non-null value for MSIS-IDENTIFICATION-NUM.” |
|
03/27/2020
|
2.4.0 |
RULE-7249
|
ADD |
Data Dictionary - Validation Rules |
N/A |
“If MANAGED-CARE-PARTICIPATION-ELG00014.RECORD-ID equals ‘ELG00014’, then MANAGED-CARE-PARTICIPATION-ELG00014 has a non-null value for MSIS-IDENTIFICATION-NUM.” |
|
03/27/2020
|
2.4.0 |
RULE-7250
|
ADD |
Data Dictionary - Validation Rules |
N/A |
“If ETHNICITY-INFORMATION-ELG00015.RECORD-ID equals ‘ELG00015’, then PRIMARY-ETHNICITY-INFORMATION-ELG00015 has a non-null value for MSIS-IDENTIFICATION-NUM.” |
|
03/27/2020
|
2.4.0 |
RULE-7251
|
ADD |
Data Dictionary - Validation Rules |
N/A |
“If RACE-INFORMATION-ELG00016.RECORD-ID equals ‘ELG00016’, then RACE-INFORMATION-ELG00016 has a non-null value for MSIS-IDENTIFICATION-NUM.” |
|
05/29/2020
|
2.4.0 |
RULE-7266
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0'
AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN ("A", "1")
AND CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to "0"
AND CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR is equal to "0" or is null
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT' |
|
05/29/2020
|
2.4.0 |
RULE-7267
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN ("A", "1")
AND CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to "0"
AND CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR is equal to "1"
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT' |
|
05/29/2020
|
2.4.0 |
RULE-7268
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN ("A", "1")
AND CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0"
AND CLAIM-HEADER-LT.CROSSOVER-INDICATOR is equal to "0" or is null
then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT' |
|
05/29/2020
|
2.4.0 |
RULE-7269
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN ("A", "1")
AND CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0"
AND CLAIM-HEADER-LT.CROSSOVER-INDICATOR is equal to "1"
then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT has a non-null and not invalidly formatted value. |
|
05/29/2020
|
2.4.0 |
RULE-7270
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN ("2", "B")
AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0"
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT ' |
|
05/29/2020
|
2.4.0 |
RULE-7271
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN ("A", "1")
AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0"
AND CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR is equal to "1"
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT' |
|
05/29/2020
|
2.4.0 |
RULE-7272
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN ("A", "1")
AND CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0"
AND CLAIM-HEADER-RX.CROSSOVER-INDICATOR is equal to "0" or is null
then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT' |
|
05/29/2020
|
2.4.0 |
RULE-7273
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654")
AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN ("A", "1")
AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0"
AND CLAIM-HEADER-OT.CROSSOVER-INDICATOR is equal to "0" or is null
then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for MEDICAID-PAID-AMT' |
|
05/29/2020
|
2.4.0 |
RULE-7274
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN ("1", "3", "A", "C")
AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND IN ("0", "4")
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-BILLED-AMT' |
|
05/29/2020
|
2.4.0 |
RULE-7275
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN ("1", "3", "A", "C")
AND CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND IN ("0", "4")
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-BILLED-AMT ' |
|
05/29/2020
|
2.4.0 |
RULE-7276
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN ("1", "3", "A", "C")
AND CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND IN ("0", "4")
then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-BILLED-AMT ' |
|
05/29/2020
|
2.4.0 |
RULE-7277
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN ("1", "3", "A", "C")
AND CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND IN ("0", "4")
then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-BILLED-AMT ' |
|
05/29/2020
|
2.4.0 |
RULE-7278
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654")
AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN ("A", "1", "C", "3")
AND CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to "0"
then Sum of CLAIM-LINE-RECORD-IP.MEDICAID-PAID-AMT is equal to CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT' |
|
05/29/2020
|
2.4.0 |
RULE-7279
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654")
AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIMIN ("A", "1", "C", "3")
AND CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0"
then Sum of CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT is equal to CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT' |
|
05/29/2020
|
2.4.0 |
RULE-7280
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654")
AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN ("A", "1", "C", "3")
AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0"
then Sum of CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT is equal to CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT.' |
|
05/29/2020
|
2.4.0 |
RULE-7281
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654")
AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN ("A", "1", "C", "3")
AND CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0"
then Sum of CLAIM-LINE-RECORD-RX.MEDICAID-PAID-AMT is equal to CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT.' |
|
05/29/2020
|
2.4.0 |
RULE-7282
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN ("A", "1", "C", "3")
AND CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to "0"
AND CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is not null
AND CLAIM-HEADER-RECORD-IP.TOT-ALLOWED-AMT is not equal to "0" and is not null
then CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-IP.TOT-ALLOWED-AMT. |
|
05/29/2020
|
2.4.0 |
RULE-7283
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN ("A", "1", "C", "3")
AND CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0"
AND CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is not null
AND CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT is not equal to "0" and is not null
then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT. |
|
05/29/2020
|
2.4.0 |
RULE-7284
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN ("A", "1", "C", "3")
AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0"
AND CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not null
AND CLAIM-HEADER-RECORD-OT.TOT-ALLOWED-AMT is not equal to "0" and is not null
then CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-OT.TOT-ALLOWED-AMT' |
|
05/29/2020
|
2.4.0 |
RULE-7285
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654")
AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN ("A", "1")
AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0"
AND CLAIM-HEADER-RECORD-OT.PAYMENT-LEVEL-IND is equal to "2"
AND CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT is not null
AND CLAIM-LINE-RECORD-OT.ALLOWED-AMT is not equal to "0" and is not null
then CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT is less than or equal to CLAIM-LINE-RECORD-OT.ALLOWED-AMT' |
|
09/11/2020
|
2.4.0 |
Rule-7349
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
and CLAIM-HEADER-RECORD-OT has a non-null value for PLACE-OF-SERVICE
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE |
|
09/11/2020
|
2.4.0 |
Rule-7351
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to the following: '1', '3', 'A', 'C'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654'
then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL
and CLAIM-HEADER-RECORD-OT has a non-null value for PLACE-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
Rule-7352
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654'
and TYPE-OF-CLAIM is equal to the following: '1', '3', 'A', 'C'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-BILL has a non-null value,
then CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE' |
|
09/11/2020
|
2.4.0 |
Rule-7353
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654'
and TYPE-OF-CLAIM is equal to the following: '1', '3', 'A', 'C'
and CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE
then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL' |
|
09/11/2020
|
2.4.0 |
Rule-7354
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654'
and TYPE-OF-CLAIM is equal to the following: '1', '3', 'A', 'C'
then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE
and CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE' |
|
09/11/2020
|
2.4.0 |
Rule-7356
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','A', '3','C'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0'
and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR is equal to '0'
then CLAIM-LINE-RECORD-RX has a non-null value for DAYS-SUPPLY' |
|
09/11/2020
|
2.4.0 |
Rule-7357
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','A', '3','C'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0'
and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR is equal to '0'
then CLAIM-LINE-RECORD-RX has a non-null value for OT-RX-CLAIM-QUANTITY-ACTUAL' |
|
08/21/2020
|
2.4.0 |
RULE-7313
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-IP.RECORD-ID is equal to 'CIP00002'
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADJUDICATION-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-7314
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-LT.RECORD-ID is equal to 'CLT00002'
then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for ADJUDICATION-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-7315
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-OT.RECORD-ID is equal to 'COT00002'
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ADJUDICATION-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-7316
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-RX.RECORD-ID is equal to 'CRX00002'
then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for ADJUDICATION-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-7317
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-LINE-RECORD-IP.RECORD-ID is equal to 'CIP00003'
then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for ADJUDICATION-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-7318
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-LINE-RECORD-LT.RECORD-ID is equal to 'CLT00003'
then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for ADJUDICATION-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-7319
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-LINE-RECORD-OT.RECORD-ID is equal to 'COT00003'
then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ADJUDICATION-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-7320
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-LINE-RECORD-RX.RECORD-ID is equal to 'CRX00003'
then CLAIM-LINE-RECORD-RX has a non-null and not invalidly formatted value for ADJUDICATION-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-7321
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
then CLAIM-HEADER-RECORD-IP
has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-7322
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-7323
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE' |
|
08/21/2020
|
2.4.0 |
RULE-7324
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4'
then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE' |
|
04/17/2020
|
2.4.0 |
RULE-7208
|
UPDATE |
Data Dictionary - Validation Rules |
IF CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is NOT in (Z)AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is NOT in ("26","026","87","087", "542","585", "654", "686")AND CLAIM-HEADER-RECORD-IP.ADJUSTEMENT-IND does not equal '1'THEN CLAIM-HEADER-IP.ADMISSION-DATE must have a valid non-null value |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C"),
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE' |
|
04/17/2020
|
2.4.0 |
RULE-7209
|
UPDATE |
Data Dictionary - Validation Rules |
IF CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0'
AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN ('Z')
AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654", "686")
AND CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654", "686")
AND CLAIM-HEADER-RECORD-IP.ADJUSTEMENT-IND does not equal '1'
THEN CLAIM-LINE-IP.BEGINNING-DATE-OF-SERVICE must have a valid non-null value |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1',
and TYPE-OF-CLAIM in ("1","3","A","C")
then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
04/17/2020
|
2.4.0 |
RULE-7210
|
UPDATE |
Data Dictionary - Validation Rules |
IF CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0'AND CLAIM-F3HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN ('Z')AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654", "686")AND CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654", "686")AND CLAIM-HEADER-RECORD-IP.ADJUSTEMENT-IND does not equal '1'THEN CLAIM-LINE-IP.ENDING-DATE-OF-SERVICE must have a valid non-null value |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1',
and TYPE-OF-CLAIM in ("1","3","A","C")
then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
04/17/2020
|
2.4.0 |
RULE-7211
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.PATIENT-STATUS does not equal '30', then CLAIM-HEADER-RECORD-IP has a valid, non-null value for DISCHARGE-DATE' |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-IP.PATIENT-STATUS does not equal '30'
and TYPE-OF-CLAIM in ("1","3","A","C"),
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for DISCHARGE-DATE' |
|
04/17/2020
|
2.4.0 |
RULE-7212
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM is NOT in (Z)AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is NOT in ("26","026","87","087", "542","585", "654", "686")AND CLAIM-HEADER-RECORD-LT.ADJUSTEMENT-IND does not equal '1'THEN CLAIM-HEADER-LT.BEGINNING-DATE-OF-SERVICE must have a valid non-null value |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C"),
then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
04/17/2020
|
2.4.0 |
RULE-7213
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM is NOT in (Z)AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is NOT in ("26","026","87","087", "542","585", "654", "686")AND CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'THEN CLAIM-HEADER-LT.ENDING-DATE-OF-SERVICE must have a valid non-null value |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C"),
then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
04/17/2020
|
2.4.0 |
RULE-7214
|
UPDATE |
Data Dictionary - Validation Rules |
IF CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is NOT in (Z)AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is NOT in ("26","026","87","087", "542","585", "654", "686")AND CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1'THEN CLAIM-HEADER-RX.PRESCRIPTION-FILL-DATE must have a valid non-null value |
IF CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is NOT in (Z)AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is NOT in ("26","026","87","087", "542","585", "654", "686")
AND CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C")
THEN CLAIM-HEADER-RX.PRESCRIPTION-FILL-DATE must have a valid, non-null and not invalidly formatted value |
|
04/17/2020
|
2.4.0 |
RULE-7215
|
UPDATE |
Data Dictionary - Validation Rules |
IF CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is NOT in (Z)AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is NOT in ("26","026","87","087", "542","585", "654", "686")AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'THEN CLAIM-HEADER-OT.BEGINNING-DATE-OF-SERVICE must have a valid non-null value |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C","2","B"),
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
04/17/2020
|
2.4.0 |
RULE-7216
|
UPDATE |
Data Dictionary - Validation Rules |
IF CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is NOT in (Z)AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is NOT in ("26","026","87","087", "542","585", "654", "686")AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'THEN CLAIM-HEADER-OT.ENDING-DATE-OF-SERVICE must have a valid non-null value |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C","2","B"),
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
04/17/2020
|
2.4.0 |
RULE-7217
|
UPDATE |
Data Dictionary - Validation Rules |
IF (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0'AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN ('Z')AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654", "686")AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654", "686")AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'THEN CLAIM-LINE-OT.BEGINNING-DATE-OF-SERVICE must have a valid non-null value |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C","2","B"),
then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
04/17/2020
|
2.4.0 |
RULE-7218
|
UPDATE |
Data Dictionary - Validation Rules |
IF (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0'AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN ('Z')AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654", "686")AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654", "686")AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'THEN CLAIM-LINE-OT.ENDING-DATE-OF-SERVICE must have a valid non-null value |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C","2","B")
then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
04/17/2020
|
2.4.0 |
RULE-7252
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C"),
then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
04/17/2020
|
2.4.0 |
RULE-7253
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C"),
then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
05/08/2020
|
2.4.0 |
RULE-7254
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
then CLAIM-LINE-RECORD-IP has a non-null value for TYPE-OF-CLAIM' |
|
05/08/2020
|
2.4.0 |
RULE-7255
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
then CLAIM-LINE-RECORD-LT has a non-null value for TYPE-OF-CLAIM' |
|
05/08/2020
|
2.4.0 |
RULE-7256
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
then CLAIM-LINE-RECORD-OT has a non-null value for TYPE-OF-CLAIM' |
|
05/08/2020
|
2.4.0 |
RULE-7257
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
then CLAIM-LINE-RECORD-RX has a non-null value for TYPE-OF-CLAIM' |
|
05/08/2020
|
2.4.0 |
RULE-7258
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to "0" or "4"
and TYPE-OF-CLAIM in ("1","3","A","C")
then CLAIM-LINE-RECORD-IP has a non-null value for TYPE-OF-SERVICE' |
|
05/08/2020
|
2.4.0 |
RULE-7259
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0" or "4"
and TYPE-OF-CLAIM in ("1","3","A","C")
then CLAIM-LINE-RECORD-LT has a non-null value for TYPE-OF-SERVICE' |
|
05/08/2020
|
2.4.0 |
RULE-7260
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" or "4"
and TYPE-OF-CLAIM in ("1","3","A","C")
then CLAIM-LINE-RECORD-OT has a non-null value for TYPE-OF-SERVICE' |
|
05/08/2020
|
2.4.0 |
RULE-7261
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0" or "4"
and TYPE-OF-CLAIM in ("1","3","A","C")
then CLAIM-LINE-RECORD-RX has a non-null value for TYPE-OF-SERVICE' |
|
05/08/2020
|
2.4.0 |
RULE-7262
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to "0" or "4"
and TYPE-OF-CLAIM in ("1","A")
then CLAIM-LINE-RECORD-IP has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
|
05/08/2020
|
2.4.0 |
RULE-7263
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0" or "4"
and TYPE-OF-CLAIM in ("1","A")
then CLAIM-LINE-RECORD-LT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
|
05/08/2020
|
2.4.0 |
RULE-7264
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" or "4"
and TYPE-OF-CLAIM in ("1","A","2","B")
then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
|
05/08/2020
|
2.4.0 |
RULE-7265
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0" or "4"
and TYPE-OF-CLAIM in ("1","A")
then CLAIM-LINE-RECORD-RX has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
|
06/19/2020
|
2.4.0 |
RULE-7301
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM |
|
06/19/2020
|
2.4.0 |
RULE-7302
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM |
|
06/19/2020
|
2.4.0 |
RULE-7303
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM |
|
06/19/2020
|
2.4.0 |
RULE-7304
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4'
then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM |
|
06/19/2020
|
2.4.0 |
RULE-7305
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NUM |
|
06/19/2020
|
2.4.0 |
RULE-7306
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NUM |
|
06/19/2020
|
2.4.0 |
RULE-7307
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM |
|
06/19/2020
|
2.4.0 |
RULE-7308
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4'
then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NUM |
|
06/19/2020
|
2.4.0 |
RULE-7309
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
then CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NPI-NUM |
|
06/19/2020
|
2.4.0 |
RULE-7310
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
then CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NPI-NUM |
|
06/19/2020
|
2.4.0 |
RULE-7311
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
then CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NPI-NUM |
|
06/19/2020
|
2.4.0 |
RULE-7312
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4'
then CLAIM-HEADER-RECORD-RX has non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI |
|
09/11/2020
|
2.4.0 |
RULE-7358
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE-PROV-ID has a non-null value
then PROV-ATTRIBUTES-MAIN has a non-null value for FACILITY-GROUP-INDIVIDUAL-CODE' |
|
09/11/2020
|
2.4.0 |
RULE-7359
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PROV-IDENTIFIERS.SUBMITTING-STATE-PROV-ID has a non-null value
then PROV-IDENTIFIERS has a non-null value for PROV-IDENTIFIER' |
|
09/11/2020
|
2.4.0 |
RULE-7360
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PROV-IDENTIFIERS.SUBMITTING-STATE-PROV-ID has a non-null value
then PROV-IDENTIFIERS has a non-null and not invalidly formatted value for PROV-IDENTIFIER-EFF-DATE' |
|
09/11/2020
|
2.4.0 |
RULE-7361
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PROV-IDENTIFIERS.SUBMITTING-STATE-PROV-ID has a non-null value
then PROV-IDENTIFIERS has a non-null value for PROV-IDENTIFIER-ISSUING-ENTITY-ID' |
|
09/11/2020
|
2.4.0 |
RULE-7362
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PROV-IDENTIFIERS.SUBMITTING-STATE-PROV-ID has a non-null value
then PROV-IDENTIFIERS has a non-null value for PROV-IDENTIFIER-TYPE' |
|
09/11/2020
|
2.4.0 |
RULE-7363
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PROV-TAXONOMY-CLASSIFICATION.SUBMITTING-STATE-PROV-ID has a non-null value
then PROV-TAXONOMY-CLASSIFICATION has a non-null value for PROV-CLASSIFICATION-CODE' |
|
09/11/2020
|
2.4.0 |
RULE-7364
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PROV-TAXONOMY-CLASSIFICATION.SUBMITTING-STATE-PROV-ID has a non-null value
then PROV-TAXONOMY-CLASSIFICATION has a non-null value for PROV-CLASSIFICATION-TYPE' |
|
12/04/2020
|
2.4.0 |
RULE-2820
|
UPDATE |
Data Dictionary - Validation Rules |
'if PROV-ATTRIBUTES-MAIN has a valid, non-null value for DATE-OF-BIRTH
and FILE-HEADER-RECORD-PROVIDER has a valid, non-null value for END-OF-TIME-PERIOD
and FILE-HEADER-RECORD-PROVIDER has a valid, non-null value for START-OF-TIME-PERIOD,
then the difference between dates PROV-ATTRIBUTES-MAIN.DATE-OF-BIRTH
and FILE-HEADER-RECORD-PROVIDER.START-OF-TIME-PERIOD is less than or equal to 85 years and the difference between dates PROV-ATTRIBUTES-MAIN.DATE-OF-BIRTH
and FILE-HEADER-RECORD-PROVIDER.START-OF-TIME-PERIOD is greater than or equal to 18 years' |
if PROV-ATTRIBUTES-MAIN segments
with PROV-ATTRIBUTES-MAIN has a non-null and not invalidly formatted value for DATE-OF-BIRTH
and
FILE-HEADER-RECORD-PROVIDER has a non-null and not invalidly formatted value for START-OF-TIME-PERIOD
and
FILE-HEADER-RECORD-PROVIDER has a non-null and not invalidly formatted value for END-OF-TIME-PERIOD
and for every record of type PROV-ATTRIBUTES-MAIN there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys
and PROV-ATTRIBUTES-MAIN has a null value for DATE-OF-DEATH
and PROV-MEDICAID-ENROLLMENT-STATUS-CODE is not equal to one of the following: ‘60’, ‘61’, ‘62’. ‘63’, ‘64’, ‘65’, ‘66’, ‘67’, ‘68’, ‘69’, ‘70’, ‘71’, ‘72’, ‘73’, ‘74’, ‘75’, ‘76’, ‘77’, ‘78’, ‘79’, ‘80’, ‘81’, ‘82’, ‘83’
then the difference between dates PROV-ATTRIBUTES-MAIN.DATE-OF-BIRTH and FILE-HEADER-RECORD-PROVIDER.START-OF-TIME-PERIOD is less than or equal to 85 years and the difference between dates PROV-ATTRIBUTES-MAIN.DATE-OF-BIRTH
and FILE-HEADER-RECORD-PROVIDER.START-OF-TIME-PERIOD is greater than or equal to 18 years' |
|
06/19/2020
|
2.4.0 |
RULE-1656
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'
and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2',
then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '131', '134', '135', '136', '137'' |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'
and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '127','131', '134', '135', '136', '137', '138', '139', '140', '141', '142', '143', '144'" |
|
03/27/2020
|
2.4.0 |
RULE-7238
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be compatible with specified T-MSIS picture format: X(10) |
|
03/27/2020
|
2.4.0 |
RULE-7233
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be compatible with specified T-MSIS picture format: X(20) |
|
03/27/2020
|
2.4.0 |
RULE-7234
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid date of the form CCYYMMDD |
|
03/27/2020
|
2.4.0 |
RULE-7232
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be compatible with specified T-MSIS picture format: X(500) |
|
03/27/2020
|
2.4.0 |
RULE-7224
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid date of the form CCYYMMDD |
|
03/27/2020
|
2.4.0 |
RULE-7241
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be compatible with specified T-MSIS picture format: X(18) |
|
03/27/2020
|
2.4.0 |
RULE-7236
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be compatible with specified T-MSIS picture format: X(20) |
|
03/27/2020
|
2.4.0 |
RULE-7229
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be compatible with specified T-MSIS picture format: X(8) |
|
03/27/2020
|
2.4.0 |
RULE-7230
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be compatible with specified T-MSIS picture format: X(2) |
|
03/27/2020
|
2.4.0 |
RULE-7231
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be compatible with specified T-MSIS picture format: X(1) |
|
03/27/2020
|
2.4.0 |
RULE-7235
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be compatible with specified T-MSIS picture format: 9(11) |
|
03/27/2020
|
2.4.0 |
RULE-7239
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'If the field is populated, the value must be contained in the set of valid values with id: 'REASON-FOR-CHANGE' and (if ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE is non-null then ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE >= Valid Values Effective-Date and ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE <= Valid Values End-Date)' |
|
03/27/2020
|
2.4.0 |
RULE-7220
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'If the field is populated, the value must be contained in the set of valid values with id: 'ELG-IDENTIFIER-TYPE' and (if ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE is non-null then ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE >= Valid Values Effective-Date and ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE <= Valid Values End-Date)' |
|
03/27/2020
|
2.4.0 |
RULE-7219
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and (if ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE is non-null then ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE >= Valid Values Effective-Date and ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE <= Valid Values End-Date)' |
|
03/27/2020
|
2.4.0 |
RULE-7227
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if ELG-IDENTIFIERS has a valid, non-null value for ELG-IDENTIFIER, then ELG-IDENTIFIERS.ELG-IDENTIFIER does not contain any pipe (|) or asterisk (*) characters' |
|
03/27/2020
|
2.4.0 |
RULE-7242
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if ELG-IDENTIFIERS has a valid, non-null value for STATE-NOTATION, then ELG-IDENTIFIERS.STATE-NOTATION does not contain any pipe (|) or asterisk (*) characters' |
|
03/27/2020
|
2.4.0 |
RULE-7222
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Field RECORD-NUMBER should be unique across all records of type ELG-IDENTIFIERS |
|
03/27/2020
|
2.4.0 |
RULE-7228
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if ELG-IDENTIFIERS has a valid, non-null value for ELG-IDENTIFIER, then ELG-IDENTIFIERS has a valid, non-null value for ELG-IDENTIFIER-TYPE' |
|
03/27/2020
|
2.4.0 |
RULE-7225
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if ELG-IDENTIFIERS has a valid, non-null value for ELG-IDENTIFIER-EFF-DATE and ELG-IDENTIFIERS has a valid, non-null value for ELG-IDENTIFIER-END-DATE, then ELG-IDENTIFIERS.ELG-IDENTIFIER-EFF-DATE is less than or equal to ELG-IDENTIFIERS.ELG-IDENTIFIER-END-DATE' |
|
03/27/2020
|
2.4.0 |
RULE-7226
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE |
|
02/21/2020
|
2.4.0 |
RULE-768
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-IP has corresponding parent record CLAIM-HEADER-RECORD-IP
Join Keys between Claim Header and Line segment:
SUBMITTING-STATE
ICN-ORIG
ICN-ADJ
ADJUDICATION-DATE/ |
if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-IP has corresponding parent record CLAIM-HEADER-RECORD-IP
Join Keys between Claim Header and Line segment:
SUBMITTING-STATE
ICN-ORIG
ICN-ADJ
ADJUDICATION-DATE
ADJUSTMENT-IND (LINE-ADJUSTMENT-IND) |
|
02/21/2020
|
2.4.0 |
RULE-1204
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-LT has corresponding parent record CLAIM-HEADER-RECORD-LT
Join Keys between Claim Header and Line segment:
SUBMITTING-STATE
ICN-ORIG
ICN-ADJ
ADJUDICATION-DATE |
if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-LT has corresponding parent record CLAIM-HEADER-RECORD-LT
Join Keys between Claim Header and Line segment:
SUBMITTING-STATE
ICN-ORIG
ICN-ADJ
ADJUDICATION-DATE
ADJUSTMENT-IND (LINE-ADJUSTMENT-IND) |
|
02/21/2020
|
2.4.0 |
RULE-1610
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-OT has corresponding parent record CLAIM-HEADER-RECORD-OT
Join Keys between Claim Header and Line segment:
SUBMITTING-STATE
ICN-ORIG
ICN-ADJ
ADJUDICATION-DATE |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-OT has corresponding parent record CLAIM-HEADER-RECORD-OT
Join Keys between Claim Header and Line segment:
SUBMITTING-STATE
ICN-ORIG
ICN-ADJ
ADJUDICATION-DATE
ADJUSTMENT-IND (LINE-ADJUSTMENT-IND) |
|
02/21/2020
|
2.4.0 |
RULE-1909
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-RX has corresponding parent record CLAIM-HEADER-RECORD-RX
Join Keys between Claim Header and Line segment:
SUBMITTING-STATE
ICN-ORIG
ICN-ADJ
ADJUDICATION-DATE |
if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then record CLAIM-LINE-RECORD-RX has corresponding parent record CLAIM-HEADER-RECORD-RX
SUBMITTING-STATE
ICN-ORIG
ICN-ADJ
ADJUDICATION-DATE
ADJUSTMENT-IND (LINE-ADJUSTMENT-IND) |
|
03/27/2020
|
2.4.0 |
RULE-7240
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if ELG-IDENTIFIERS has a valid, non-null value for SUBMITTING-STATE and FILE-HEADER-RECORD-ELIGIBILITY has a valid, non-null value for SUBMITTING-STATE, then ELG-IDENTIFIERS.SUBMITTING-STATE refers to the same state as FILE-HEADER-RECORD-ELIGIBILITY.SUBMITTING-STATE' |
|
06/19/2020
|
2.4.0 |
RULE-7209
|
UPDATE |
Data Dictionary - Validation Rules |
One Record Type(Single Record) |
Two Record Type (1 to 1) |
|
06/19/2020
|
2.4.0 |
RULE-7217
|
UPDATE |
Data Dictionary - Validation Rules |
One Record Type(Single Record) |
Two Record Type (1 to 1) |
|
06/19/2020
|
2.4.0 |
RULE-7218
|
UPDATE |
Data Dictionary - Validation Rules |
One Record Type(Single Record) |
Two Record Type (1 to 1) |
|
04/17/2020
|
2.4.0 |
RULE-807
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '001', '058', '060', '084', '086', '090', '091', '092', '093', '123', '132', '135'' |
if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '001', '058', '060', '084', '086', '090', '091', '092', '093', '123', '132', '135','136','137'' |
|
04/17/2020
|
2.4.0 |
RULE-1244
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '009', '044', '045', '046', '047', '048', '050', '059', '133'' |
if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '009', '044', '045', '046', '047', '048', '050', '059', '133','136','137'' |
|
04/17/2020
|
2.4.0 |
RULE-1656
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '087', '088', '089', '115', '119', '120', '121', '122', '131', '134', '135'' |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '087', '088', '089', '115', '119', '120', '121', '122', '131', '134', '135','136','137'' |
|
04/17/2020
|
2.4.0 |
RULE-1938
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '011', '018', '033', '034', '036', '085', '089', '127', '131'' |
if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '011', '018', '033', '034', '036', '085', '089', '127', '131','136','137'' |
|
07/31/2020
|
2.4.0 |
RULE-559
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and (CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '0' or CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W'), then CLAIM-HEADER-RECORD-IP.MEDICARE-COMB-DED-IND equals '0'' |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '0' then CLAIM-HEADER-RECORD-IP.MEDICARE-COMB-DED-IND equals '0'' |
|
07/31/2020
|
2.4.0 |
RULE-998
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and (CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0' or CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W'), then CLAIM-HEADER-RECORD-LT.MEDICARE-COMB-DED-IND equals '0'' |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and (CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0' then CLAIM-HEADER-RECORD-LT.MEDICARE-COMB-DED-IND equals '0'' |
|
07/31/2020
|
2.4.0 |
RULE-1417
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and (CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' or CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W'), then CLAIM-HEADER-RECORD-OT.MEDICARE-COMB-DED-IND equals '0'' |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' then CLAIM-HEADER-RECORD-OT.MEDICARE-COMB-DED-IND equals '0'' |
|
07/31/2020
|
2.4.0 |
RULE-1971
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and (CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' or CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W'), then CLAIM-HEADER-RECORD-RX.MEDICARE-COMB-DED-IND equals '0'' |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' then CLAIM-HEADER-RECORD-RX.MEDICARE-COMB-DED-IND equals '0'. |
|
05/29/2020
|
2.4.0 |
RULE-2068
|
UPDATE |
Data Dictionary - Validation Rules |
'if ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND equals '1', then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '3', '4'' |
'if ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND equals '1', then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '3'" |
|
07/31/2020
|
2.4.0 |
RULE-7293
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to the following values: '26', '026', '87', '087', '542', '585', '654'
and For every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type CLAIM-LINE-RECORD-OT that matches on the join keys (SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND=LINE-ADJSTMT-IND)
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to the following values: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE-FLAG
then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE' |
|
07/31/2020
|
2.4.0 |
RULE-7294
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to the following values: '26', '026', '87', '087', '542', '585', '654'
and For every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type CLAIM-LINE-RECORD-OT that matches on the join keys (SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND=LINE-ADJSTMT-IND)
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to the following values: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE,
then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE-FLAG' |
|
07/31/2020
|
2.4.0 |
RULE-7287
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-1
then CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-FLAG-1' |
|
07/31/2020
|
2.4.0 |
RULE-7288
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-2
then CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-FLAG-2' |
|
07/31/2020
|
2.4.0 |
RULE-7289
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-3
then CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-FLAG-3' |
|
07/31/2020
|
2.4.0 |
RULE-7290
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-4
then CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-FLAG-4' |
|
07/31/2020
|
2.4.0 |
RULE-7291
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-5
then CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-FLAG-5' |
|
07/31/2020
|
2.4.0 |
RULE-7292
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-6
then CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-FLAG-6' |
|
06/19/2020
|
2.4.0 |
RULE-7295
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '138', '139', '140', '141', '142', '143' ,'144'
AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2',
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
AND CLAIM-HEADER-RECORD-OT.MSIS-IDENTIFICATION-NUM is a valid, non-null value
AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'
then CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '2' or 'B' |
|
06/19/2020
|
2.4.0 |
RULE-7296
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2',
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'
AND CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to '138'
then CLAIM-HEADER-RECORD-OT has a non-null value for 'HEALTH-HOME-ENTITY-NAME' |
|
11/13/2020
|
2.4.0 |
RULE-7350
|
ADD |
Data Dictionary - Validation Rules |
N/A |
(PROV-MEDICAID-ENROLLMENT Record segment with the distinct combination of
SUBMITTING-STATE, SUBMITTING-STATE-PROV-ID, PROV-MEDICAID-ENROLLMENT-STATUS-CODE
and STATE-PLAN-ENROLLMENT = 3)
AND
(PROV-MEDICAID-ENROLLMENT Record segment with the same distinct combination of
SUBMITTING-STATE, SUBMITTING-STATE-PROV-ID, PROV-MEDICAID-ENROLLMENT-STATUS-CODE
and STATE-PLAN-ENROLLMENT in (1,2))
must have non-overlapping date ranges. |
|
06/19/2020
|
2.4.0 |
RULE-2806
|
UPDATE |
Data Dictionary - Validation Rules |
if and only if PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03', then PROV-ATTRIBUTES-MAIN has a valid, non-null value for PROV-FIRST-NAME' |
if PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03', then PROV-ATTRIBUTES-MAIN has a valid, non-null value for PROV-FIRST-NAME' |
|
06/19/2020
|
2.4.0 |
RULE-2810
|
UPDATE |
Data Dictionary - Validation Rules |
'if and only if PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03', then PROV-ATTRIBUTES-MAIN has a valid, non-null value for PROV-LAST-NAME' |
if PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03', then PROV-ATTRIBUTES-MAIN has a valid, non-null value for PROV-LAST-NAME' |
|
06/19/2020
|
2.4.0 |
RULE-2817
|
UPDATE |
Data Dictionary - Validation Rules |
'if and only if PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03', then PROV-ATTRIBUTES-MAIN has a valid, non-null value for DATE-OF-BIRTH' |
if PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03', then PROV-ATTRIBUTES-MAIN has a valid, non-null value for DATE-OF-BIRTH' |
|
06/19/2020
|
2.4.0 |
RULE-414
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-1, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-1' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-1, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-1' |
|
06/19/2020
|
2.4.0 |
RULE-426
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-FLAG-2, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-2' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-FLAG-2, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-2' |
|
06/19/2020
|
2.4.0 |
RULE-480
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-6, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-6' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-6, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-6' |
|
06/19/2020
|
2.4.0 |
RULE-1121
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-LT has a valid, non-null value for WAIVER-TYPE, then CLAIM-HEADER-RECORD-LT has a valid, non-null value for WAIVER-ID' |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-LT has a valid, non-null value for WAIVER-TYPE, then CLAIM-HEADER-RECORD-LT has a valid, non-null value for WAIVER-ID' |
|
06/19/2020
|
2.4.0 |
RULE-1234
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-LINE-RECORD-LT has a valid, non-null value for REVENUE-CODE, then CLAIM-LINE-RECORD-LT has a valid, non-null value for REVENUE-CHARGE' |
'if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-LINE-RECORD-LT has a valid, non-null value for REVENUE-CODE, then CLAIM-LINE-RECORD-LT has a valid, non-null value for REVENUE-CHARGE' |
|
06/19/2020
|
2.4.0 |
RULE-1535
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-OT has a valid, non-null value for WAIVER-TYPE, then CLAIM-HEADER-RECORD-OT has a valid, non-null value for WAIVER-ID' |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-OT has a valid, non-null value for WAIVER-TYPE, then CLAIM-HEADER-RECORD-OT has a valid, non-null value for WAIVER-ID' |
|
06/19/2020
|
2.4.0 |
RULE-1840
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-RX has a valid, non-null value for WAIVER-TYPE, then CLAIM-HEADER-RECORD-RX has a valid, non-null value for WAIVER-ID' |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-RX has a valid, non-null value for WAIVER-TYPE, then CLAIM-HEADER-RECORD-RX has a valid, non-null value for WAIVER-ID' |
|
06/19/2020
|
2.4.0 |
RULE-2331
|
UPDATE |
Data Dictionary - Validation Rules |
'if and only if WAIVER-PARTICIPATION has a valid, non-null value for WAIVER-TYPE, then WAIVER-PARTICIPATION has a valid, non-null value for WAIVER-ID' |
'if WAIVER-PARTICIPATION has a valid, non-null value for WAIVER-TYPE, then WAIVER-PARTICIPATION has a valid, non-null value for WAIVER-ID' |
|
06/19/2020
|
2.4.0 |
RULE-439
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-3, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-3' |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-3, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-3' |
|
06/19/2020
|
2.4.0 |
RULE-453
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-4, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-4''if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-4, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-4' |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-4, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-4' |
|
06/19/2020
|
2.4.0 |
RULE-467
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-5, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-5' |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-5, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-5' |
|
06/19/2020
|
2.4.0 |
RULE-683
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP has a valid, non-null value for WAIVER-TYPE, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for WAIVER-ID' |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a valid, non-null value for WAIVER-TYPE, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for WAIVER-ID' |
|
06/19/2020
|
2.4.0 |
RULE-798
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-LINE-RECORD-IP has a valid, non-null value for REVENUE-CODE, then CLAIM-LINE-RECORD-IP has a valid, non-null value for REVENUE-CHARGE' |
'if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-LINE-RECORD-IP has a valid, non-null value for REVENUE-CODE, then CLAIM-LINE-RECORD-IP has a valid, non-null value for REVENUE-CHARGE' |
|
08/21/2020
|
2.4.0 |
RULE-690
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-IP.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM
and TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
then CLAIM-HEADER-RECORD-IP.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
|
08/21/2020
|
2.4.0 |
RULE-1127
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for BILLING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-LT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
then CLAIM-HEADER-RECORD-LT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
|
08/21/2020
|
2.4.0 |
RULE-1541
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM
and CLAIM-HEADER-RECORD-OT. TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
then CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
|
08/21/2020
|
2.4.0 |
RULE-1846
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-RX.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM
and TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
then CLAIM-HEADER-RECORD-RX.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
|
08/21/2020
|
2.4.0 |
RULE-693
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
then If the CLAIM-HEADER-RECORD-IP.PROV-TAXONOMY is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
|
08/21/2020
|
2.4.0 |
RULE-1130
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
then If the CLAIM-HEADER-RECORD-LT.PROV-TAXONOMY is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
|
08/21/2020
|
2.4.0 |
RULE-1545
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
then If the CLAIM-HEADER-RECORD-OT.PROV-TAXONOMY is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
|
08/21/2020
|
2.4.0 |
RULE-1849
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
then If the field is populated, the CLAIM-HEADER-RECORD-RX. BILLING-PROV-TAXONOMY must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
|
05/18/2018
|
2.2.0 |
RULE-572
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for NON-COV-DAYS and CLAIM-HEADER-RECORD-IP has a valid, non-null value for MEDICAID-COV-INPATIENT-DAYS, then the sum of CLAIM-HEADER-RECORD-IP.NON-COV-DAYS and CLAIM-HEADER-RECORD-IP.MEDICAID-COV-INPATIENT-DAYS is less than or equal to the number of days between the earliest CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE date and the latest CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE date', where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS does not equal '585' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for NON-COV-DAYS and CLAIM-HEADER-RECORD-IP has a valid, non-null value for MEDICAID-COV-INPATIENT-DAYS, then the sum of CLAIM-HEADER-RECORD-IP.NON-COV-DAYS and CLAIM-HEADER-RECORD-IP.MEDICAID-COV-INPATIENT-DAYS is less than or equal to the number of days between the earliest CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE date and the latest CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE date plus one day', where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS does not equal '585' |
|
05/18/2018
|
2.2.0 |
RULE-1011
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for NON-COV-DAYS and CLAIM-HEADER-RECORD-LT has a valid, non-null value for MEDICAID-COV-INPATIENT-DAYS and CLAIM-HEADER-RECORD-LT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT has a valid, non-null value for ENDING-DATE-OF-SERVICE, then the sum of CLAIM-HEADER-RECORD-LT.NON-COV-DAYS and CLAIM-HEADER-RECORD-LT.MEDICAID-COV-INPATIENT-DAYS is less than or equal to the number of days between CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for NON-COV-DAYS and CLAIM-HEADER-RECORD-LT has a valid, non-null value for MEDICAID-COV-INPATIENT-DAYS and CLAIM-HEADER-RECORD-LT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT has a valid, non-null value for ENDING-DATE-OF-SERVICE, then the sum of CLAIM-HEADER-RECORD-LT.NON-COV-DAYS and CLAIM-HEADER-RECORD-LT.MEDICAID-COV-INPATIENT-DAYS is less than or equal to the number of days between CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE, plus one day' |
|
06/19/2020
|
2.4.0 |
RULE-426
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-FLAG-2, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-2' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-2, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-2' |
|
11/13/2020
|
2.4.0 |
Rule-7325
|
ADD |
Data Dictionary - Validation Rules |
N/A |
For every record of type CLAIM-HEADER-RECORD-RX,
ICN-ORIG must have a non-null value' |
|
11/13/2020
|
2.4.0 |
Rule-7326
|
ADD |
Data Dictionary - Validation Rules |
N/A |
For every record of type CLAIM-HEADER-RECORD-OT,
ICN-ORIG must have a non-null value' |
|
11/13/2020
|
2.4.0 |
Rule-7327
|
ADD |
Data Dictionary - Validation Rules |
N/A |
For every record of type CLAIM-HEADER-RECORD-LT,
ICN-ORIG must have a non-null value' |
|
11/13/2020
|
2.4.0 |
Rule-7328
|
ADD |
Data Dictionary - Validation Rules |
N/A |
For every record of type CLAIM-HEADER-RECORD-IP,
ICN-ORIG must have a non-null value' |
|
11/13/2020
|
2.4.0 |
Rule-7329
|
ADD |
Data Dictionary - Validation Rules |
N/A |
For every record of type CLAIM-LINE-RECORD-RX,
ICN-ORIG must have a non-null value' |
|
11/13/2020
|
2.4.0 |
Rule-7330
|
ADD |
Data Dictionary - Validation Rules |
N/A |
For every record of type CLAIM-LINE-RECORD-OT,
ICN-ORIG must have a non-null value' |
|
11/13/2020
|
2.4.0 |
Rule-7331
|
ADD |
Data Dictionary - Validation Rules |
N/A |
For every record of type CLAIM-LINE-RECORD-LT,
ICN-ORIG must have a non-null value' |
|
11/13/2020
|
2.4.0 |
Rule-7332
|
ADD |
Data Dictionary - Validation Rules |
N/A |
For every record of type CLAIM-LINE-RECORD-IP,
ICN-ORIG must have a non-null value' |
|
08/21/2020
|
2.4.0 |
RULE-7333
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '5', '6'
then CLAIM-HEADER-RECORD-IP has a null value for ICN-ADJ' |
|
08/21/2020
|
2.4.0 |
RULE-7334
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '5', '6'
then CLAIM-HEADER-RECORD-LT has a null value for ICN-ADJ' |
|
08/21/2020
|
2.4.0 |
RULE-7336
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '5', '6'
then CLAIM-HEADER-RECORD-OT has a null value for ICN-ADJ' |
|
08/21/2020
|
2.4.0 |
RULE-7335
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '5', '6'
then CLAIM-HEADER-RECORD-RX has a null value for ICN-ADJ' |
|
08/21/2020
|
2.4.0 |
RULE-7337
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-IP has a null value for ICN-ADJ
then CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '5', '6'' |
|
08/21/2020
|
2.4.0 |
RULE-7338
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-LT has a null value for ICN-ADJ
then CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '5', '6'' |
|
08/21/2020
|
2.4.0 |
RULE-7339
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-OT has a null value for ICN-ADJ
then CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '5', '6'' |
|
08/21/2020
|
2.4.0 |
RULE-7340
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-RX has a null value for ICN-ADJ
then CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '5', '6'' |
|
08/21/2020
|
2.4.0 |
RULE-7341
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '4', '1'
then CLAIM-HEADER-RECORD-IP has a non-null value for ICN-ADJ' |
|
08/21/2020
|
2.4.0 |
RULE-7342
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '4', '1'
then CLAIM-HEADER-RECORD-LT has a non-null value for ICN-ADJ' |
|
08/21/2020
|
2.4.0 |
RULE-7343
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '4', '1'
then CLAIM-HEADER-RECORD-OT has a non-null value for ICN-ADJ' |
|
08/21/2020
|
2.4.0 |
RULE-7344
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '4', '1'
then CLAIM-HEADER-RECORD-RX has a non-null value for ICN-ADJ' |
|
08/21/2020
|
2.4.0 |
RULE-7345
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-IP has a non-null value for ICN-ADJ
then CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '4', '1' |
|
08/21/2020
|
2.4.0 |
RULE-7346
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-LT has a non-null value for ICN-ADJ
then CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '4', '1' |
|
08/21/2020
|
2.4.0 |
RULE-7347
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-OT has a non-null value for ICN-ADJ
then CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '4', '1' |
|
08/21/2020
|
2.4.0 |
RULE-7348
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if CLAIM-HEADER-RECORD-RX has a non-null value for ICN-ADJ
then CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '4', '1' |
|
09/11/2020
|
2.4.0 |
RULE-2143
|
UPDATE |
Data Dictionary - Validation Rules |
if ELIGIBILITY-DETERMINANTS.SSI-STATUS equals '003' or ELIGIBILITY-DETERMINANTS has a null or invalid value for SSI-STATUS, then ELIGIBILITY-DETERMINANTS.SSI-IND equals '0' |
if ELIGIBILITY-DETERMINANTS.SSI-STATUS equals ‘003' or '000’ or ELIGIBILITY-DETERMINANTS has a null or invalid value for SSI-STATUS, then ELIGIBILITY-DETERMINANTS.SSI-IND equals '0' |
|
11/13/2020
|
2.4.0 |
Rule-7297
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2',
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT has a non-null value for MSIS-IDENTIFICATION-NUM
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '139', '140', '141','142'
and For every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM)
and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE
and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE
then ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is not equal to null or '00' |
|
09/11/2020
|
2.4.0 |
RULE-7204
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not in ('Z','3','C','W') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1' then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01' |
|
09/11/2020
|
2.4.0 |
RULE-7205
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM not in ('Z','3','C','W') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01' |
|
09/11/2020
|
2.4.0 |
RULE-7206
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM not in ('Z','3','C','W') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01' |
|
09/11/2020
|
2.4.0 |
RULE-7207
|
UPDATE |
Data Dictionary - Validation Rules |
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.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01' |
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.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM not in ('Z','3','C','W') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01' |
|
09/11/2020
|
2.4.0 |
RULE-824
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM not in ('Z','3','C','W') and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02' |
|
09/11/2020
|
2.4.0 |
RULE-1256
|
UPDATE |
Data Dictionary - Validation Rules |
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.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02' |
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.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM not in ('Z','3','C','W') and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02' |
|
09/11/2020
|
2.4.0 |
RULE-1691
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not in ('Z','3','C','W') and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02' |
|
09/11/2020
|
2.4.0 |
RULE-1955
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF- CLAIM not in ('Z','3','C','W') and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02 |
|
09/11/2020
|
2.4.0 |
RULE-7372
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7373
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7374
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7375
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0" or "4"
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7376
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to 'A'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7377
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to 'A'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7378
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'A'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7379
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to 'A'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7380
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MSIS-IDENTIFICATION-NUM has a non-null value then VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for CITIZENSHIP-IND' |
|
09/11/2020
|
2.4.0 |
RULE-7381
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MSIS-IDENTIFICATION-NUM has a non-null value then VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for IMMIGRATION-STATUS' |
|
09/11/2020
|
2.4.0 |
RULE-7382
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE' |
|
09/11/2020
|
2.4.0 |
RULE-7383
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for DISCHARGE-DATE' |
|
09/11/2020
|
2.4.0 |
RULE-7394
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7392
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26' '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7393
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D',
then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7395
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7396
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7397
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7398
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7399
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7404
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-LT has a non-null value for SERVICE-TRACKING-TYPE' |
|
09/11/2020
|
2.4.0 |
RULE-7405
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-OT has a non-null value for SERVICE-TRACKING-TYPE' |
|
09/11/2020
|
2.4.0 |
RULE-7406
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-RX has a non-null value for SERVICE-TRACKING-TYPE' |
|
09/11/2020
|
2.4.0 |
RULE-7400
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT' |
|
09/11/2020
|
2.4.0 |
RULE-7401
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT' |
|
09/11/2020
|
2.4.0 |
RULE-7402
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT' |
|
09/11/2020
|
2.4.0 |
RULE-7403
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT' |
|
09/11/2020
|
2.4.0 |
RULE-7384
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7386
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7387
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7388
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7385
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to 'D'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7389
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to 'D'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7390
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'D'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
09/11/2020
|
2.4.0 |
RULE-7391
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to 'D'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
10/02/2020
|
2.4.0 |
Rule-7423
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM
and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE has non-null and not invalidly formatted value
and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value
and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE
and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE
and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null and not invalidly formatted value for DATE-OF-BIRTH
then
((if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has non-null and not invalidly formatted value for DATE-OF-DEATH
then the difference between dates PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-BIRTH
and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH is between -1 and 120 years)
or (if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has null value for DATE-OF-DEATH
then the difference between dates PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-BIRTH
and FILE-HEADER-RECORD-ELIGIBILITY.START-OF-TIME-PERIOD is between -1 and 120 years)) |
|
10/02/2020
|
2.4.0 |
RULE-775
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for LINE-NUM-ADJ and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-IP has a valid, non-null value for LINE-ADJUSTMENT-IND' |
N/A |
|
10/02/2020
|
2.4.0 |
RULE-1917
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for LINE-NUM-ADJ and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX has a valid, non-null value for LINE-ADJUSTMENT-IND' |
N/A |
|
10/02/2020
|
2.4.0 |
RULE-1617
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for LINE-NUM-ADJ and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT has a valid, non-null value for LINE-ADJUSTMENT-IND' |
N/A |
|
10/02/2020
|
2.4.0 |
RULE-1212
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for LINE-NUM-ADJ and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT has a valid, non-null value for LINE-ADJUSTMENT-IND' |
N/A |
|
10/02/2020
|
2.4.0 |
Rule-7412
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0'
AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN ("1", "3")
AND CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR is equal to "1"
AND CLAIM-HEADER-RECORD-IP has a non-null value for MSIS-IDENTIFICATION-NUM'
AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE has non-null and not invalidly formatted value
and ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE has non-null and not invalidly formatted value
and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE
and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE
AND ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to "1"
THEN ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01','02','03','04','05','06','08','09','10' |
|
10/02/2020
|
2.4.0 |
Rule-7413
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0'
AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN ("1", "3")
AND CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR is equal to "1"
AND CLAIM-HEADER-RECORD-LT has a non-null value for MSIS-IDENTIFICATION-NUM'
AND CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE has non-null and not invalidly formatted value
and ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE has non-null and not invalidly formatted value
and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE
and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE
AND ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to "1"
THEN ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01','02','03','04','05','06','08','09','10' |
|
10/02/2020
|
2.4.0 |
Rule-7414
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0'
AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN ("1", "3")
AND CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR is equal to "1"
AND CLAIM-HEADER-RECORD-RX has a non-null value for MSIS-IDENTIFICATION-NUM'
AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non-null and not invalidly formatted value
and ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE has non-null and not invalidly formatted value
and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE
and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE
AND ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to "1"
THEN ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01','02','03','04','05','06','08','09','10' |
|
10/02/2020
|
2.4.0 |
Rule-7424
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0'
AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to "Z"
AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN ("1", "3")
AND CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR is equal to "1"
AND CLAIM-HEADER-RECORD-OT has a non-null value for MSIS-IDENTIFICATION-NUM'
AND CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE has non-null and not invalidly formatted value
and ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE has non-null and not invalidly formatted value
and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE
and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE
AND ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to "1"
THEN ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01','02','03','04','05','06','08','09','10' |
|
10/02/2020
|
2.4.0 |
Rule-7419
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE
AND ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
AND ELIGIBILITY-DETERMINANTS.ELIGIBLE-GROUP is equal to one of the following: '23', '24', '25' ,'26'
THEN then ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01','02','03','04','05', '06', '08','09', '10' O10 |
|
10/02/2020
|
2.4.0 |
Rule-7420
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE
AND ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to '3'
AND ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
then ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01','03','05', '06' |
|
10/02/2020
|
2.4.0 |
Rule-7421
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE
AND ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01','03','05', '06'
AND ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
then ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to '3' |
|
10/02/2020
|
2.4.0 |
Rule-7370
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM
then ELIGIBILITY-DETERMINANTS has a non-null value for RESTRICTED-BENEFITS-CODE |
|
10/02/2020
|
2.4.0 |
Rule-7371
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If ENROLLMENT-TIME-SPAN has a non-null value for MSIS-IDENTIFICATION-NUM
then ENROLLMENT-TIME-SPAN has a non-null value for ENROLLMENT-TYPE |
|
10/02/2020
|
2.4.0 |
Rule-7407
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if MANAGED-CARE-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM
and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value
and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value
and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE
and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE
and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-TYPE is equal to one of the following: '01', '02', '03', '04', '05', '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', 20', '60', '70', '80'
then MANAGED-CARE-PARTICIPATION has a non-null value for MANAGED-CARE-PLAN-ID |
|
10/02/2020
|
2.4.0 |
Rule-7408
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if MANAGED-CARE-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM
and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value
and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value
and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE
and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE
and MANAGED-CARE-PARTICIPATION has a non-null value for MANAGED-CARE-PLAN-ID
then MANAGED-CARE-PARTICIPATION has a non-null value for MANAGED-CARE-PLAN-TYPE |
|
10/02/2020
|
2.4.0 |
Rule-7411
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to '6'
then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP is equal to one of the following: ' 35', '70'. |
|
12/04/2020
|
2.4.0 |
RULE-7443
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NUM
then For every record of type CLAIM-LINE-RECORD-IP, (there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys (CLAIM-LINE-RECORD-IP.SUBMITTING-STATE, CLAIM-LINE-RECORD-IP.SERVICING-PROV-NUM
with PROV-MEDICAID-ENROLLMENT.SUBMITTING-STATE, PROV-MEDICAID-ENROLLMENT. SUBMITTING-STATE-PROV-ID)
where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
and (CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is greater than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE
and CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE)) |
|
12/04/2020
|
2.4.0 |
RULE-7444
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NUM
then For every record of type CLAIM-LINE-RECORD-LT, (there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys (CLAIM-LINE-RECORD-LT.SUBMITTING-STATE, CLAIM-LINE-RECORD-LT.SERVICING-PROV-NUM
with PROV-MEDICAID-ENROLLMENT.SUBMITTING-STATE, PROV-MEDICAID-ENROLLMENT. SUBMITTING-STATE-PROV-ID)
where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
and (CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE is greater than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE and CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE is less than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE)) |
|
12/04/2020
|
2.4.0 |
RULE-7445
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NUM
then For every record of type CLAIM-LINE-RECORD-OT, (there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys (CLAIM-LINE-RECORD-OT.SUBMITTING-STATE, CLAIM-LINE-RECORD-OT.SERVICING-PROV-NUM
with PROV-MEDICAID-ENROLLMENT.SUBMITTING-STATE, PROV-MEDICAID-ENROLLMENT. SUBMITTING-STATE-PROV-ID)
where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
and (CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is greater than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE
and CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE)) |
|
12/04/2020
|
2.4.0 |
RULE-7446
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C'
and CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM
then For every record of type CLAIM-HEADER-RECORD-RX, (there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE, CLAIM-HEADER-RECORD-RX.DISPENSING-PRESCRIPTION-DRUG-PROV-NUM with PROV-MEDICAID-ENROLLMENT.SUBMITTING-STATE, PROV-MEDICAID-ENROLLMENT. SUBMITTING-STATE-PROV-ID)
where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06'
and (CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is greater than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE
and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is less than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE)) |
|
07/02/2021
|
3.0.0 |
RULE-7427
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if WAIVER-PARTICIPATION.WAIVER-TYPE is equal to '24',
then for every record of type WAIVER-PARTICIPATION, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM),
and (WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE >= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE
and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE <= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE),
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to '6' |
|
07/02/2021
|
3.0.0 |
RULE-7428
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to 'C',
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM)
and (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE),
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '3' |
|
07/02/2021
|
3.0.0 |
RULE-7429
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if MFP-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM
then for every record of type MFP-INFORMATION, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM)
and (MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE
and MFP-INFORMATION.MFP-ENROLLMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE),
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to 'D' |
|
07/02/2021
|
3.0.0 |
RULE-7430
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to 'D'
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type MFP-INFORMATION that matches on the join keys
(ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE >= MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE) |
|
11/13/2020
|
2.4.0 |
Rule-7351
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL and CLAIM-HEADER-RECORD-OT has a non-null value for PLACE-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to the following: '1', '3', 'A', 'C'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654'
then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL
or CLAIM-HEADER-RECORD-OT has a non-null value for PLACE-OF-SERVICE' |
|
11/13/2020
|
2.4.0 |
Rule-7354
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE and CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654'
and TYPE-OF-CLAIM is equal to the following: '1', '3', 'A', 'C'
then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE
or CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE' |
|
11/13/2020
|
2.4.0 |
Rule-7384
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
11/13/2020
|
2.4.0 |
Rule-7386
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
11/13/2020
|
2.4.0 |
Rule-7387
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
11/13/2020
|
2.4.0 |
Rule-7388
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal '4'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal '4'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
11/13/2020
|
2.4.0 |
Rule-7372
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
11/13/2020
|
2.4.0 |
Rule-7373
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
11/13/2020
|
2.4.0 |
Rule-7374
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
11/13/2020
|
2.4.0 |
Rule-7375
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
11/13/2020
|
2.4.0 |
RULE-1423
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-OT.BILLING-PROV-NUM' |
N/A |
|
11/13/2020
|
2.4.0 |
RULE-7431
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then record CLAIM-HEADER-RECORD-IP has corresponding child record CLAIM-LINE-RECORD-IP |
|
11/13/2020
|
2.4.0 |
RULE-7432
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM is not equal to 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then record CLAIM-HEADER-RECORD-LT has corresponding child record CLAIM-LINE-RECORD-LT |
|
11/13/2020
|
2.4.0 |
RULE-7433
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then record CLAIM-HEADER-RECORD-OT has corresponding child record CLAIM-LINE-RECORD-OT |
|
11/13/2020
|
2.4.0 |
RULE-7434
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then record CLAIM-HEADER-RECORD-RX has corresponding child record CLAIM-LINE-RECORD-RX |
|
11/13/2020
|
2.4.0 |
RULE-7439
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654')
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C'
and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NUM
then For every record of type CLAIM-HEADER-RECORD-IP, (there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys
(CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE, CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM with PROV-MEDICAID-ENROLLMENT.SUBMITTING-STATE, PROV-MEDICAID-ENROLLMENT. SUBMITTING-STATE-PROV-ID)
where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '40', '05', '06'
and (CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is greater than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE
and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is less than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE)) |
|
11/13/2020
|
2.4.0 |
RULE-7440
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C'
and CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NUM
then For every record of type CLAIM-HEADER-RECORD-LT (there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM
with PROV-MEDICAID-ENROLLMENT.SUBMITTING-STATE, PROV-MEDICAID-ENROLLMENT. SUBMITTING-STATE-PROV-ID)
where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '40', '05', '06'
and (CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE is greater than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE
and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE is less than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE)) |
|
11/13/2020
|
2.4.0 |
RULE-7441
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C'
and CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM
then For every record of type CLAIM-HEADER-RECORD-OT, (there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys (CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-OT.BILLING-PROV-NUM
with PROV-MEDICAID-ENROLLMENT.SUBMITTING-STATE, PROV-MEDICAID-ENROLLMENT. SUBMITTING-STATE-PROV-ID)
where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '40', '05', '06'
and (CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE is greater than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE
and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE)) |
|
11/13/2020
|
2.4.0 |
RULE-7442
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C'
and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NUM
then For every record of type CLAIM-HEADER-RECORD-RX, (there must be a valid record of type PROV-MEDICAID-ENROLLMENT that matches on join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE, CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM
with PROV-MEDICAID-ENROLLMENT.SUBMITTING-STATE, PROV-MEDICAID-ENROLLMENT. SUBMITTING-STATE-PROV-ID)
where PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-ENROLLMENT-STATUS-CODE is equal to one of the following: '01', '02', '03', '40', '05', '06'
and (CLAIM-HEADER-RECORD-RX. PRESCRIPTION-FILL-DATE is greater than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE
and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is less than or equal to PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-END-DATE)) |
|
11/13/2020
|
2.4.0 |
RULE-7435
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICAID-PAID-AMT' |
|
11/13/2020
|
2.4.0 |
RULE-7436
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICAID-PAID-AMT' |
|
11/13/2020
|
2.4.0 |
RULE-7437
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICAID-PAID-AMT' |
|
11/13/2020
|
2.4.0 |
RULE-7438
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICAID-PAID-AMT' |
|
12/04/2020
|
2.4.0 |
RULE-7448
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR is equal to '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
then (CLAIM-HEADER-RECORD-IP has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT is equal to 0.00)
and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT is equal to 0.00)
and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT is equal to 0.00) |
|
12/04/2020
|
2.4.0 |
RULE-7449
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR is equal to '0'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
then (CLAIM-HEADER-RECORD-LT has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT is equal to 0.00)
and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is equal to 0.00)
and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT is equal to 0.00) |
|
12/04/2020
|
2.4.0 |
RULE-7450
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR is equal to '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
and for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type CLAIM-LINE-RECORD-OT that matches on the join keys
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
then (CLAIM-HEADER-RECORD-OT has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-OT.MEDICARE-PAID-AMT is equal to 0.00)
and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT is equal to 0.00)
and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT is equal to 0.00) |
|
12/04/2020
|
2.4.0 |
RULE-7451
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR is equal to '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
and for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type CLAIM-LINE-RECORD-RX that matches on the join keys
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
then (CLAIM-HEADER-RECORD-RX has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-RX.MEDICARE-PAID-AMT is equal to 0.00)
and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT is equal to 0.00)
and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT is equal to 0.00) |
|
12/04/2020
|
2.4.0 |
RULE-7452
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR is equal to '1'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
then (CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for MEDICARE-PAID-AMT
or CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT
or CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT) |
|
12/04/2020
|
2.4.0 |
RULE-7453
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR is equal to '1'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
then (CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for MEDICARE-PAID-AMT
or CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT
or CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT) |
|
12/04/2020
|
2.4.0 |
RULE-7454
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR is equal to '1'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
and for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type CLAIM-LINE-RECORD-OT that matches on the join keys
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
then (CLAIM-LINE-RECORD-OT has a non-null value and not invalidly formatted value for MEDICARE-PAID-AMT
or CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT
or CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT) |
|
12/04/2020
|
2.4.0 |
RULE-7455
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR is equal to '1'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
and for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type CLAIM-LINE-RECORD-RX that matches on the join keys
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
then (CLAIM-LINE-RECORD-RX has a non-null value and not invalidly formatted value for MEDICARE-PAID-AMT
or CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT
or CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT) |
|
07/23/2021
|
3.0.0 |
RULE-7409
|
UPDATE |
Data Dictionary - Validation Rules |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE has non-null and not invalidly formatted value
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '2'
then ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '07','31','61 |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '2'
then For every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)
and (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))
and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '07','31','61'
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01' |
|
07/23/2021
|
3.0.0 |
RULE-7410
|
UPDATE |
Data Dictionary - Validation Rules |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE has non-null and not invalidly formatted value
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '3'
then ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '61','62','63','64','65','66','67','68'. |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '3'
then For every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)
and (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))
and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '61','62','63','64','65','66','67','68'
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01' |
|
07/23/2021
|
3.0.0 |
RULE-7422
|
UPDATE |
Data Dictionary - Validation Rules |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE has non-null and not invalidly formatted value
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021 has a non-null value for MSIS-IDENTIFICATION-NUM
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value
and ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE has non-null and not invalidly formatted value
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-END-DATE
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-ELG00021.ENROLLMENT-EFF-DATE
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1'
then ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '61','62','63','64','65','66','67','68'. |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1'
then For every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)
and (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))
and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is not equal to one of the following: '61','62','63','64','65','66','67','68'
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01' |
|
12/04/2020
|
2.4.0 |
RULE-423
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-1, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-1' |
N/A |
|
12/04/2020
|
2.4.0 |
RULE-436
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-2 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-2' |
N/A |
|
12/04/2020
|
2.4.0 |
RULE-449
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-3 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-3' |
N/A |
|
12/04/2020
|
2.4.0 |
RULE-463
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-4 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-4' |
N/A |
|
12/04/2020
|
2.4.0 |
RULE-476
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-5 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-5' |
N/A |
|
12/04/2020
|
2.4.0 |
RULE-488
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-6 and CLAIM-LINE-RECORD-IP has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-6' |
N/A |
|
01/27/2021
|
3.0.0 |
RULE-532
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X',
then CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT equals '0.00'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X',
then (CLAIM-HEADER-RECORD-IP has a null value for TOT-BILLED-AMT or CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT is equal to 0.00)' |
|
01/27/2021
|
3.0.0 |
RULE-545
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.MEDICARE-COMB-DED-IND equals '1',
then CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT equals '0.00'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.MEDICARE-COMB-DED-IND equals '1',
then (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT is equal to 0.00) |
|
01/27/2021
|
3.0.0 |
RULE-710
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.OUTLIER-CODE is equal to one of the following: '00', '09',
then CLAIM-HEADER-RECORD-IP has a null or invalid value for DRG-OUTLIER-AMT or CLAIM-HEADER-RECORD-IP.DRG-OUTLIER-AMT equals '0.00'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.OUTLIER-CODE is equal to one of the following: '00', '09',
then (CLAIM-HEADER-RECORD-IP has a null value for DRG-OUTLIER-AMT or CLAIM-HEADER-RECORD-IP.DRG-OUTLIER-AMT is equal to 0.00) |
|
01/27/2021
|
3.0.0 |
RULE-984
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.MEDICARE-COMB-DED-IND equals '1', then CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT equals '0.00'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-LT.MEDICARE-COMB-DED-IND equals '1',
then (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is equal to 0.00) |
|
01/27/2021
|
3.0.0 |
RULE-1403
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.MEDICARE-COMB-DED-IND equals '1',
then CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT equals '0.00'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.MEDICARE-COMB-DED-IND equals '1',
then (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT is equal to 0.00) |
|
01/27/2021
|
3.0.0 |
RULE-1788
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X', then CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT equals '0.00'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X',
then (CLAIM-HEADER-RECORD-RX has a null value for TOT-BILLED-AMT or CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT is equal to 0.00) |
|
01/27/2021
|
3.0.0 |
RULE-1801
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.MEDICARE-COMB-DED-IND equals '1',
then CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT equals '0.00'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.MEDICARE-COMB-DED-IND equals '1',
then (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT is equal to 0.00) |
|
12/04/2020
|
2.4.0 |
RULE-7447
|
ADD |
Data Dictionary - Validation Rules |
N/A |
‘if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1',
then ELIGIBILITY-DETERMINANTS has a non-null value for ELIGIBILITY-GROUP’ |
|
01/27/2021
|
3.0.0 |
RULE-7372
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '5'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
01/27/2021
|
3.0.0 |
RULE-7373
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '5'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
01/27/2021
|
3.0.0 |
RULE-7374
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '2', '5'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
01/27/2021
|
3.0.0 |
RULE-7375
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '5'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
01/27/2021
|
3.0.0 |
RULE-7376
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to 'A'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
01/27/2021
|
3.0.0 |
RULE-7377
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to 'A'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
01/27/2021
|
3.0.0 |
RULE-7378
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'A'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', 'B', 'E'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
01/27/2021
|
3.0.0 |
RULE-7379
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to 'A'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
12/04/2020
|
2.4.0 |
RULE-7372
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '5'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
12/04/2020
|
2.4.0 |
RULE-7373
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '5'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
12/04/2020
|
2.4.0 |
RULE-7374
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '2', '5'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
12/04/2020
|
2.4.0 |
RULE-7375
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '5'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
12/04/2020
|
2.4.0 |
RULE-7376
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to 'A'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
12/04/2020
|
2.4.0 |
RULE-7377
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to 'A'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
12/04/2020
|
2.4.0 |
RULE-7378
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'A'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', 'B', 'E'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
12/04/2020
|
2.4.0 |
RULE-7379
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to 'A'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
01/27/2021
|
3.0.0 |
RULE-7384
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
01/27/2021
|
3.0.0 |
RULE-7385
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to 'D'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
01/27/2021
|
3.0.0 |
RULE-7386
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
01/27/2021
|
3.0.0 |
RULE-7387
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
01/27/2021
|
3.0.0 |
RULE-7388
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal '4'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
01/27/2021
|
3.0.0 |
RULE-7389
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to 'D'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
01/27/2021
|
3.0.0 |
RULE-7390
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'D'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
01/27/2021
|
3.0.0 |
RULE-7391
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to 'D'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
12/04/2020
|
2.4.0 |
RULE-7384
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
12/04/2020
|
2.4.0 |
RULE-7385
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to 'D'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
12/04/2020
|
2.4.0 |
RULE-7386
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
12/04/2020
|
2.4.0 |
RULE-7387
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
12/04/2020
|
2.4.0 |
RULE-7388
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal '4'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE'
or CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
12/04/2020
|
2.4.0 |
RULE-7389
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to 'D'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
12/04/2020
|
2.4.0 |
RULE-7390
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to 'D'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
12/04/2020
|
2.4.0 |
RULE-7391
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to 'D'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
12/04/2020
|
2.4.0 |
RULE-7435
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICAID-PAID-AMT' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is equal to 0.00) |
|
12/04/2020
|
2.4.0 |
RULE-7436
|
UPDATE |
Data Dictionary - Validation Rules |
'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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICAID-PAID-AMT' |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is equal to 0.00)' |
|
12/04/2020
|
2.4.0 |
RULE-7437
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICAID-PAID-AMT' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is equal to 0.00)' |
|
12/04/2020
|
2.4.0 |
RULE-7438
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICAID-PAID-AMT' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is equal to 0.00)' |
|
01/27/2021
|
3.0.0 |
RULE-1871
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH
and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PRESCRIPTION-FILL-DATE,
then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' .'686'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH
and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PRESCRIPTION-FILL-DATE,
then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
|
01/27/2021
|
3.0.0 |
RULE-7200
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER,
then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE) |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER,
then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE) |
|
01/27/2021
|
3.0.0 |
RULE-7196
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654','686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER,
then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
|
01/27/2021
|
3.0.0 |
RULE-1337
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654','686'
then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
|
01/27/2021
|
3.0.0 |
RULE-884
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
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.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '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 for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
|
01/27/2021
|
3.0.0 |
RULE-1691
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654','686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654','686'
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3',
then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'' |
|
01/27/2021
|
3.0.0 |
RULE-1955
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3',
then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'' |
|
01/27/2021
|
3.0.0 |
RULE-824
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3',
then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'' |
|
01/27/2021
|
3.0.0 |
RULE-7204
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' , '686'
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1',
then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'' |
|
01/27/2021
|
3.0.0 |
RULE-7205
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1',
then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'' |
|
01/27/2021
|
3.0.0 |
RULE-7206
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '1',
then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01'' |
|
01/27/2021
|
3.0.0 |
RULE-519
|
UPDATE |
Data Dictionary - Validation Rules |
if ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '00' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then CLAIM-HEADER-RECORD-IP.ALLOWED-CHARGE-SRC is not equal to one of the following: '1', 'I', 'K', 'M'' |
if ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '00'
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to CLAIM-HEADER-RECORD-IP.ADMISSION-DATE
and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal ‘F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686’
then CLAIM-HEADER-RECORD-IP.ALLOWED-CHARGE-SRC is not equal to one of the following: '1', 'I', 'K', 'M''
then CLAIM-HEADER-RECORD-IP.ALLOWED-CHARGE-SRC is not equal to one of the following: '1', 'I', 'K', 'M'' |
|
02/05/2021
|
3.0.0 |
RULE-689
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-IP, ((there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and CLAIM-HEADER-RECORD-IP has a null value for DISCHARGE-DATE or CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE must be in (PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE, PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-IP has a null value for DISCHARGE-DATE or CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE must be in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))) |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM,
then for every record of type CLAIM-HEADER-RECORD-IP, ((there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1'
and CLAIM-HEADER-RECORD-IP has a null value for DISCHARGE-DATE
or CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE must be in (PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE, PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE))
OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys
and CLAIM-HEADER-RECORD-IP has a null value for DISCHARGE-DATE
or CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE must be in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))) |
|
02/05/2021
|
3.0.0 |
RULE-1126
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-LT, ((there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))) |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-LT, ((there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))) |
|
02/05/2021
|
3.0.0 |
RULE-1540
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-OT, ((there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))) |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '2', 'B', 'V'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NUM,
then for every record of type CLAIM-HEADER-RECORD-OT, ((there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))) |
|
02/05/2021
|
3.0.0 |
RULE-1845
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, ((there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE, PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))) |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, ((there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE, PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))) |
|
02/05/2021
|
3.0.0 |
RULE-810
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-IP, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-IP, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) |
|
02/05/2021
|
3.0.0 |
RULE-1246
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-LT, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-LT, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-LINE-RECORD-LT.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) |
|
02/05/2021
|
3.0.0 |
RULE-1663
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-OT, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '2', 'B', 'V'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM,
then for every record of type CLAIM-LINE-RECORD-OT, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) |
|
02/05/2021
|
3.0.0 |
RULE-1964
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W', '2', 'B', 'V', '4', 'D', 'X' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE, PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) |
if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM, then for every record of type CLAIM-HEADER-RECORD-RX, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE, PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) |
|
04/30/2021
|
3.0.0 |
RULE-7458
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if WAIVER-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM
and WAIVER-PARTICIPATION.WAIVER-TYPE is equal to one of the following: '01', '21', '22', '23', '24', '25', '26', '27','28', '29', '30'
then substr(WAIVER-PARTICIPATION.WAIVER-ID, 1, 5) must be in ('11-W-' or '21-W-')
and substr(WAIVER-PARTICIPATION.WAIVER-ID, 6, 5) must be equal to 0-9 digits
and substr(WAIVER-PARTICIPATION.WAIVER-ID, 11, 1) must be equal to '/'
and substr(WAIVER-PARTICIPATION.WAIVER-ID, 12, 1) must be equal to 0-9 digits) |
|
04/30/2021
|
3.0.0 |
RULE-7459
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if WAIVER-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM
and WAIVER-TYPE is equal to one of the following: '02', '03', '04', '05', '06', '07', '08','09', '10', '11, '12', '13', '14', '15', '16', '17', '18','19', '20', '32', '33'
then substr(WAIVER-PARTICIPATION.WAIVER-ID, 1, 2) must be in (A-Z/a-z)
and substr(WAIVER-PARTICIPATION.WAIVER-ID, 3, 1) must be equal to '.'
and substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 7) must be equal to 0-9 digits) |
|
04/30/2021
|
3.0.0 |
RULE-7460
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-OT.HCBS-SERVICE-CODE is equal to '4'
then CLAIM-HEADER-RECORD-OT has a non-null value for WAIVER-ID |
|
01/27/2021
|
3.0.0 |
RULE-2051
|
UPDATE |
Data Dictionary - Validation Rules |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CITIZENSHIP-IND equals '1', then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.IMMIGRATION-STATUS equals '8'' |
‘if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CITIZENSHIP-IND is equal to one of the following: '1', '2’ then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.IMMIGRATION-STATUS equals '8'' |
|
01/27/2021
|
3.0.0 |
RULE-2157
|
UPDATE |
Data Dictionary - Validation Rules |
if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '2', then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CITIZENSHIP-IND does not equal '1'' |
if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '2',
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CITIZENSHIP-IND is not equal to one of the following: '1', '2' |
|
02/26/2021
|
3.0.0 |
RULE-7464
|
ADD |
Data Dictionary - Validation Rules |
N/A |
For every record of type CLAIM-HEADER-RECORD-IP,
ADJUSTMENT-IND must have a non-null value' |
|
02/26/2021
|
3.0.0 |
RULE-7465
|
ADD |
Data Dictionary - Validation Rules |
N/A |
For every record of type CLAIM-HEADER-RECORD-LT,
ADJUSTMENT-IND must have a non-null value' |
|
02/26/2021
|
3.0.0 |
RULE-7466
|
ADD |
Data Dictionary - Validation Rules |
N/A |
For every record of type CLAIM-HEADER-RECORD-OT,
ADJUSTMENT-IND must have a non-null value' |
|
02/26/2021
|
3.0.0 |
RULE-7467
|
ADD |
Data Dictionary - Validation Rules |
N/A |
For every record of type CLAIM-HEADER-RECORD-RX,
ADJUSTMENT-IND must have a non-null value' |
|
02/26/2021
|
3.0.0 |
RULE-7468
|
ADD |
Data Dictionary - Validation Rules |
N/A |
For every record of type CLAIM-LINE-RECORD-IP,
LINE-ADJUSTMENT-IND must have a non-null value' |
|
02/26/2021
|
3.0.0 |
RULE-7469
|
ADD |
Data Dictionary - Validation Rules |
N/A |
For every record of type CLAIM-LINE-RECORD-LT,
LINE-ADJUSTMENT-IND must have a non-null value' |
|
02/26/2021
|
3.0.0 |
RULE-7470
|
ADD |
Data Dictionary - Validation Rules |
N/A |
For every record of type CLAIM-LINE-RECORD-OT,
LINE-ADJUSTMENT-IND must have a non-null value' |
|
02/26/2021
|
3.0.0 |
RULE-7471
|
ADD |
Data Dictionary - Validation Rules |
N/A |
For every record of type CLAIM-LINE-RECORD-RX,
LINE-ADJUSTMENT-IND must have a non-null value' |
|
02/26/2021
|
3.0.0 |
RULE-2133
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If there is only one ELIGIBILITY-DETERMINANTS-ELG00005 record segment identified via segment key data elements SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, and MSIS-CASE-NUM,
then PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' |
|
02/05/2021
|
3.0.0 |
RULE-1372
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2',
then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
‘if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal ‘F2',and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal ‘0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: ‘26’, ‘87’, ‘542’, '585’, '654’, '686’ and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
then if the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
07/02/2021
|
3.0.0 |
RULE-7447
|
UPDATE |
Data Dictionary - Validation Rules |
'if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1',
then ELIGIBILITY-DETERMINANTS has a non-null value for ELIGIBILITY-GROUP' |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1'
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '01/01/2015'
then ELIGIBILITY-DETERMINANTS has a non-null value for ELIGIBILITY-GROUP' |
|
07/02/2021
|
3.0.0 |
RULE-7411
|
UPDATE |
Data Dictionary - Validation Rules |
if ELIGIBILITY-DETERMINANTS has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-END-DATE and ENROLLMENT-TIME-SPAN-SEGMENT has a valid, non-null value for MSIS-IDENTIFICATION-NUM and ENROLLMENT-TIME-SPAN-SEGMENT has a non-null and not invalidly formatted value for ENROLLMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT has a non-null and not invalidly formatted value for ENROLLMENT-END-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE are overlapping with ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '6', |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to '6'
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '01/01/2015'
then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP is equal to one of the following: '35', '70 |
|
04/30/2021
|
3.0.0 |
RULE-3089
|
UPDATE |
Data Dictionary - Validation Rules |
if TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for GROUP-NUM, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.GROUP-NUM does not contain any pipe (|) or asterisk (*) characters' |
‘if TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for GROUP-NUM, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.GROUP-NUM does not contain any pipe (|) characters’ |
|
04/30/2021
|
3.0.0 |
RULE-3090
|
UPDATE |
Data Dictionary - Validation Rules |
if TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for MEMBER-ID, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.MEMBER-ID does not contain any pipe (|) or asterisk (*) characters' |
‘if TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for MEMBER-ID, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.MEMBER-ID does not contain any pipe (|) characters’ |
|
04/30/2021
|
3.0.0 |
RULE-3094
|
UPDATE |
Data Dictionary - Validation Rules |
if TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for POLICY-OWNER-FIRST-NAME, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.POLICY-OWNER-FIRST-NAME does not contain any pipe (|) or asterisk (*) characters' |
if TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for POLICY-OWNER-FIRST-NAME, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.POLICY-OWNER-FIRST-NAME does not contain any pipe (|) characters' |
|
04/30/2021
|
3.0.0 |
RULE-3095
|
UPDATE |
Data Dictionary - Validation Rules |
if TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for POLICY-OWNER-LAST-NAME, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.POLICY-OWNER-LAST-NAME does not contain any pipe (|) or asterisk (*) characters' |
if TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for POLICY-OWNER-LAST-NAME, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.POLICY-OWNER-LAST-NAME does not contain any pipe (|) characters' |
|
03/19/2021
|
3.0.0 |
RULE-7372
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '5'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-IP has a null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is not equal to 0.00
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01',
then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
|
03/19/2021
|
3.0.0 |
RULE-7373
|
UPDATE |
Data Dictionary - Validation Rules |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '5'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-LT has a null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is not equal to 0.00
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01',
then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
|
03/19/2021
|
3.0.0 |
RULE-7374
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '2', '5'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT has a null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not equal to 0.00
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01',
then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
|
03/19/2021
|
3.0.0 |
RULE-7375
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '5'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-RX has a null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is not equal to 0.00
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01',
then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
|
03/19/2021
|
3.0.0 |
RULE-7376
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-IP has a null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is not equal to 0.00
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02',
then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
03/19/2021
|
3.0.0 |
RULE-7377
|
UPDATE |
Data Dictionary - Validation Rules |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-LT has a null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is not equal to 0.00
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02',
then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
03/19/2021
|
3.0.0 |
RULE-7378
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', 'B', 'E' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', 'B', 'E'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT has a null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not equal to 0.00
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02',
then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
03/19/2021
|
3.0.0 |
RULE-7379
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'A', 'E'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-RX has a null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is not equal to 0.00
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02',
then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
05/21/2021
|
3.0.0 |
RULE-7472
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PROV-IDENTIFIERS has a non-null value for PROV-IDENTIFIER
and PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2',
then PROV-IDENTIFIERS.PROV-IDENTIFIER is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file |
|
05/21/2021
|
3.0.0 |
RULE-7473
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PROV-IDENTIFIERS has a non-null value for PROV-IDENTIFIER
and PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2',
then PROV-IDENTIFIERS.PROV-IDENTIFIER is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
and PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE is greater than or equal to "Provider Enumeration Date" from the NPPES NPI data file |
|
04/09/2021
|
3.0.0 |
RULE-7513
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z'
then CLAIM-HEADER-RECORD-IP has a null value for SERVICE-TRACKING-TYPE
or CLAIM-HEADER-RECORD-IP.SERVICE-TRACKING-TYPE is equal to one of the following: '0', '00' |
|
04/09/2021
|
3.0.0 |
RULE-7514
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z'
then CLAIM-HEADER-RECORD-LT has a null value for SERVICE-TRACKING-TYPE
or CLAIM-HEADER-RECORD-LT.SERVICE-TRACKING-TYPE is equal to one of the following: '0', '00' |
|
04/09/2021
|
3.0.0 |
RULE-7515
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z'
then CLAIM-HEADER-RECORD-OT has a null value for SERVICE-TRACKING-TYPE
or CLAIM-HEADER-RECORD-OT.SERVICE-TRACKING-TYPE is equal to one of the following: '0', '00' |
|
04/09/2021
|
3.0.0 |
RULE-7516
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z'
then CLAIM-HEADER-RECORD-RX has a null value for SERVICE-TRACKING-TYPE
or CLAIM-HEADER-RECORD-RX.SERVICE-TRACKING-TYPE is equal to one of the following: '0', '00' |
|
04/30/2021
|
3.0.0 |
RULE-7517
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z'
then (CLAIM-HEADER-RECORD-IP has a null a value for SERVICE-TRACKING-PAYMENT-AMT)
or (CLAIM-HEADER-RECORD-IP.SERVICE-TRACKING-PAYMENT-AMT is equal to 0.00) |
|
04/30/2021
|
3.0.0 |
RULE-7518
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z'
then (CLAIM-HEADER-RECORD-LT has a null value for SERVICE-TRACKING-PAYMENT-AMT)
or (CLAIM-HEADER-RECORD-LT.SERVICE-TRACKING-PAYMENT-AMT is equal to 0.00) |
|
04/30/2021
|
3.0.0 |
RULE-7519
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z'
then (CLAIM-HEADER-RECORD-OT has a null value for SERVICE-TRACKING-PAYMENT-AMT)
or (CLAIM-HEADER-RECORD-OT.SERVICE-TRACKING-PAYMENT-AMT is equal to 0.00) |
|
04/30/2021
|
3.0.0 |
RULE-7520
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z'
then (CLAIM-HEADER-RECORD-RX has a null value for SERVICE-TRACKING-PAYMENT-AMT)
or (CLAIM-HEADER-RECORD-RX.SERVICE-TRACKING-PAYMENT-AMT is equal to 0.00) |
|
04/09/2021
|
3.0.0 |
RULE-7521
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
then CLAIM-HEADER-RECORD-IP has a non-null value for SERVICE-TRACKING-TYPE' |
|
04/09/2021
|
3.0.0 |
RULE-1244
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '009', '044', '045', '046', '047', '048', '050', '059', '133', '136', '137'' |
if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '009', '044', '045', '046', '047', '048', '050', '059', '133', '136', '137', '146'' |
|
04/30/2021
|
3.0.0 |
RULE-7522
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E',
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is not equal to 0.00 |
|
04/30/2021
|
3.0.0 |
RULE-7523
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E',
then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is not equal to 0.00' |
|
04/30/2021
|
3.0.0 |
RULE-7524
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E',
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is not equal to 0.00' |
|
04/30/2021
|
3.0.0 |
RULE-1651
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'C', '3', 'W', then CLAIM-LINE-RECORD-OT has a valid, non-null value for MEDICAID-FFS-EQUIVALENT-AMT' |
N/A |
|
04/30/2021
|
3.0.0 |
RULE-804
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: 'C', '3', 'W', then CLAIM-LINE-RECORD-IP has a valid, non-null value for MEDICAID-FFS-EQUIVALENT-AMT' |
N/A |
|
04/30/2021
|
3.0.0 |
RULE-1930
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'C', '3', 'W', then CLAIM-LINE-RECORD-RX has a valid, non-null value for MEDICAID-FFS-EQUIVALENT-AMT' |
N/A |
|
04/30/2021
|
3.0.0 |
RULE-1241
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'C', '3', 'W', then CLAIM-LINE-RECORD-LT has a valid, non-null value for MEDICAID-FFS-EQUIVALENT-AMT' |
N/A |
|
05/21/2021
|
3.0.0 |
RULE-7528
|
ADD |
Data Dictionary - Validation Rules |
N/A |
‘if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.IMMIGRATION-STATUS equals '8'
then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CITIZENSHIP-IND is equal to one of the following: '1', '2’ |
|
05/21/2021
|
3.0.0 |
RULE-7531
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If ENROLLMENT-TIME-SPAN has a non-null value for MSIS-IDENTIFICATION-NUM
then for every record of type ENROLLMENT-TIME-SPAN, there must be a valid record of type ELIGIBLE-CONTACT-INFORMATION that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM)
and ELIGIBLE-CONTACT-INFORMATION.ADDR-TYPE is equal to '01' |
|
04/30/2021
|
3.0.0 |
RULE-335
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W'and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
|
04/30/2021
|
3.0.0 |
RULE-1758
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W'and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
|
05/21/2021
|
3.0.0 |
RULE-2726
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE |
N/A |
|
05/21/2021
|
3.0.0 |
RULE-2750
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE |
N/A |
|
04/30/2021
|
3.0.0 |
RULE-7533
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '5', 'A', 'E'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT does not equal 0.00
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
then CLAIM-LINE-RECORD-IP has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
04/30/2021
|
3.0.0 |
RULE-7534
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '5', 'A', 'E'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT does not equal 0.00
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
then CLAIM-LINE-RECORD-LT has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
04/30/2021
|
3.0.0 |
RULE-7535
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '2', '5', 'A', 'B', 'E'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT does not equal 0.00
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
then CLAIM-LINE-RECORD-OT has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
04/30/2021
|
3.0.0 |
RULE-7536
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '5', 'A', 'E'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT does not equal 0.00
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE
then CLAIM-LINE-RECORD-RX has a null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
04/09/2021
|
3.0.0 |
RULE-7435
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is equal to 0.00) |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is equal to 0.00) |
|
04/09/2021
|
3.0.0 |
RULE-7436
|
UPDATE |
Data Dictionary - Validation Rules |
'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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is equal to 0.00)' |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is equal to 0.00)' |
|
04/09/2021
|
3.0.0 |
RULE-7437
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is equal to 0.00)' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is equal to 0.00)' |
|
04/09/2021
|
3.0.0 |
RULE-7438
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is equal to 0.00)' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is equal to 0.00)' |
|
04/30/2021
|
3.0.0 |
RULE-7384
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4'and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4'and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
04/30/2021
|
3.0.0 |
RULE-7385
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' '686'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
04/30/2021
|
3.0.0 |
RULE-7386
|
UPDATE |
Data Dictionary - Validation Rules |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4'and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4'and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
04/30/2021
|
3.0.0 |
RULE-7387
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4'and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4'and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
04/30/2021
|
3.0.0 |
RULE-7388
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '4'and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '4'and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
04/30/2021
|
3.0.0 |
RULE-7389
|
UPDATE |
Data Dictionary - Validation Rules |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
04/30/2021
|
3.0.0 |
RULE-7390
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
04/30/2021
|
3.0.0 |
RULE-7391
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMTand CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
05/21/2021
|
3.0.0 |
RULE-7474
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM
then CLAIM-HEADER-RECORD-IP.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM
then CLAIM-HEADER-RECORD-IP.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
|
05/21/2021
|
3.0.0 |
RULE-7475
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'
and CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NPI-NUM,
then CLAIM-LINE-RECORD-IP.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654','686'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NPI-NUM,
then CLAIM-LINE-RECORD-IP.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
|
05/21/2021
|
3.0.0 |
RULE-7476
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP has a non-null value for ADMITTING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-IP.ADMITTING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP has a non-null value for ADMITTING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-IP.ADMITTING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
|
05/21/2021
|
3.0.0 |
RULE-7477
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP has a non-null value for REFERRING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-IP.REFERRING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP has a non-null value for REFERRING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-IP.REFERRING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
|
05/21/2021
|
3.0.0 |
RULE-7478
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP has a non-null value for HEALTH-HOME-PROVIDER-NPI,
then CLAIM-HEADER-RECORD-IP.HEALTH-HOME-PROVIDER-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP has a non-null value for HEALTH-HOME-PROVIDER-NPI,
then CLAIM-HEADER-RECORD-IP.HEALTH-HOME-PROVIDER-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
|
05/21/2021
|
3.0.0 |
RULE-7479
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'
and CLAIM-LINE-RECORD-IP has a non-null value for OPERATING-PROV-NPI-NUM,
then CLAIM-LINE-RECORD-IP.OPERATING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-IP has a non-null value for OPERATING-PROV-NPI-NUM,
then CLAIM-LINE-RECORD-IP.OPERATING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
|
05/21/2021
|
3.0.0 |
RULE-7482
|
UPDATE |
Data Dictionary - Validation Rules |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-LT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
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'
and CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-LT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
|
05/21/2021
|
3.0.0 |
RULE-7483
|
UPDATE |
Data Dictionary - Validation Rules |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'
and CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NPI-NUM,
then CLAIM-LINE-RECORD-LT.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
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'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NPI-NUM,
then CLAIM-LINE-RECORD-LT.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
|
05/21/2021
|
3.0.0 |
RULE-7484
|
UPDATE |
Data Dictionary - Validation Rules |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT has a non-null value for ADMITTING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-LT.ADMITTING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
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'
and CLAIM-HEADER-RECORD-LT has a non-null value for ADMITTING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-LT.ADMITTING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
|
05/21/2021
|
3.0.0 |
RULE-7485
|
UPDATE |
Data Dictionary - Validation Rules |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT has a non-null value for REFERRING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-LT.REFERRING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
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'
and CLAIM-HEADER-RECORD-LT has a non-null value for REFERRING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-LT.REFERRING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
|
05/21/2021
|
3.0.0 |
RULE-7489
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
|
05/21/2021
|
3.0.0 |
RULE-7490
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'
and CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NPI-NUM,
then CLAIM-LINE-RECORD-OT.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NPI-NUM,
then CLAIM-LINE-RECORD-OT.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
|
05/21/2021
|
3.0.0 |
RULE-7491
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT has a non-null value for REFERRING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-OT.REFERRING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file. |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' , '686'
and CLAIM-HEADER-RECORD-OT has a non-null value for REFERRING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-OT.REFERRING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file. |
|
05/21/2021
|
3.0.0 |
RULE-7495
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-RX.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-RX.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
|
05/21/2021
|
3.0.0 |
RULE-7496
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX has a non-null value for PRESCRIBING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-RX.PRESCRIBING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-RX has a non-null value for PRESCRIBING-PROV-NPI-NUM,
then CLAIM-HEADER-RECORD-RX.PRESCRIBING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
|
05/21/2021
|
3.0.0 |
RULE-7497
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI,
then CLAIM-HEADER-RECORD-RX.DISPENSING-PRESCRIPTION-DRUG-PROV-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI,
then CLAIM-HEADER-RECORD-RX.DISPENSING-PRESCRIPTION-DRUG-PROV-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
|
05/21/2021
|
3.0.0 |
RULE-7498
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX has a non-null value for HEALTH-HOME-PROVIDER-NPI,
then CLAIM-HEADER-RECORD-RX.HEALTH-HOME-PROVIDER-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-RX has a non-null value for HEALTH-HOME-PROVIDER-NPI,
then CLAIM-HEADER-RECORD-RX.HEALTH-HOME-PROVIDER-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file' |
|
05/21/2021
|
3.0.0 |
RULE-7486
|
UPDATE |
Data Dictionary - Validation Rules |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT has a non-null value for HEALTH-HOME-PROVIDER-NPI,
then CLAIM-HEADER-RECORD-LT.HEALTH-HOME-PROVIDER-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file |
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'
and CLAIM-HEADER-RECORD-LT has a non-null value for HEALTH-HOME-PROVIDER-NPI,
then CLAIM-HEADER-RECORD-LT.HEALTH-HOME-PROVIDER-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file |
|
05/21/2021
|
3.0.0 |
RULE-7492
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT has a non-null value for HEALTH-HOME-PROVIDER-NPI,
then CLAIM-HEADER-RECORD-OT.HEALTH-HOME-PROVIDER-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT has a non-null value for HEALTH-HOME-PROVIDER-NPI,
then CLAIM-HEADER-RECORD-OT.HEALTH-HOME-PROVIDER-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file |
|
05/21/2021
|
3.0.0 |
RULE-7494
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT has a non-null value for UNDER-SUPERVISION-OF-PROV-NPI,
then CLAIM-HEADER-RECORD-OT.UNDER-SUPERVISION-OF-PROV-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT has a non-null value for UNDER-SUPERVISION-OF-PROV-NPI,
then CLAIM-HEADER-RECORD-OT.UNDER-SUPERVISION-OF-PROV-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file |
|
05/21/2021
|
3.0.0 |
RULE-7507
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM,
and CLAIM-HEADER-RECORD-IP.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
then the "Entity Type Code" is equal to '2' in the NPPES data file |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM,
and CLAIM-HEADER-RECORD-IP.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
then the "Entity Type Code" is equal to '2' in the NPPES data file |
|
05/21/2021
|
3.0.0 |
RULE-7508
|
UPDATE |
Data Dictionary - Validation Rules |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM,
and CLAIM-HEADER-RECORD-LT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
then the "Entity Type Code" is equal to '2' in the NPPES data file |
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'
and CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM,
and CLAIM-HEADER-RECORD-LT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
then the "Entity Type Code" is equal to '2' in the NPPES data file |
|
05/21/2021
|
3.0.0 |
RULE-7509
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM,
and CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
then the "Entity Type Code" is equal to '2' or '1' in the NPPES data file |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM,
and CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
then the "Entity Type Code" is equal to '2' or '1' in the NPPES data file |
|
05/21/2021
|
3.0.0 |
RULE-7510
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM,
and CLAIM-HEADER-RECORD-RX.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
then the "Entity Type Code" is equal to '2' in the NPPES data file |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM,
and CLAIM-HEADER-RECORD-RX.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
then the "Entity Type Code" is equal to '2' in the NPPES data file |
|
05/21/2021
|
3.0.0 |
RULE-7511
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX has a non-null value for PRESCRIBING-PROV-NPI-NUM,
and CLAIM-HEADER-RECORD-RX.PRESCRIBING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
then the "Entity Type Code" is equal to '1' in the NPPES data file |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-RX has a non-null value for PRESCRIBING-PROV-NPI-NUM,
and CLAIM-HEADER-RECORD-RX.PRESCRIBING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
then the "Entity Type Code" is equal to '1' in the NPPES data file |
|
05/21/2021
|
3.0.0 |
RULE-7512
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI,
and CLAIM-HEADER-RECORD-RX.DISPENSING-PRESCRIPTION-DRUG-PROV-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
then the "Entity Type Code" is equal to '1' in the NPPES data file |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI,
and CLAIM-HEADER-RECORD-RX.DISPENSING-PRESCRIPTION-DRUG-PROV-NPI is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
then the "Entity Type Code" is equal to '1' in the NPPES data file |
|
05/21/2021
|
3.0.0 |
RULE-1854
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2',
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'
and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null
then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
05/21/2021
|
3.0.0 |
RULE-898
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', 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' |
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 is not equal to '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' |
|
05/21/2021
|
3.0.0 |
RULE-451
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-4, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 is a valid value specified by CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 or is a state valid value from 'PROCEDURE-CODE-STATE'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 is '01', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 should be a valid value in 'CPT'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 is '02', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 should be a valid value in 'ICD-9-PROCEDURE-CODE'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 is '06', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 should be a valid value in 'HCPCS'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 is '07', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 should be a valid value in 'ICD-10-PROCEDURE-CODE'.' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-4,
then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 is a valid value specified by CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 or is a state valid value from 'PROCEDURE-CODE-STATE'.
when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 is '01', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 should be a valid value in 'CPT'.
when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 is '02', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 should be a valid value in 'ICD-9-PROCEDURE-CODE'.
when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 is '06', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 should be a valid value in 'HCPCS'.
when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-4 is '07', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-4 should be a valid value in 'ICD-10-PROCEDURE-CODE'.' |
|
05/21/2021
|
3.0.0 |
RULE-465
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-5, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 is a valid value specified by CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 or is a state valid value from 'PROCEDURE-CODE-STATE'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 is '01', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 should be a valid value in 'CPT'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 is '02', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 should be a valid value in 'ICD-9-PROCEDURE-CODE'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 is '06', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 should be a valid value in 'HCPCS'. when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 is '07', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 should be a valid value in 'ICD-10-PROCEDURE-CODE'.' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-5,
then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 is a valid value specified by CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 or is a state valid value from 'PROCEDURE-CODE-STATE'.
when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 is '01', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 should be a valid value in 'CPT'.
when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 is '02', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 should be a valid value in 'ICD-9-PROCEDURE-CODE'.
when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 is '06', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 should be a valid value in 'HCPCS'.
when CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-5 is '07', CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-5 should be a valid value in 'ICD-10-PROCEDURE-CODE'.' |
|
05/21/2021
|
3.0.0 |
RULE-521
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then The values of the following fields should be unique for each CLAIM-HEADER-RECORD-IP record: CLAIM-PYMT-REM-CODE-1, CLAIM-PYMT-REM-CODE-2, CLAIM-PYMT-REM-CODE-3, CLAIM-PYMT-REM-CODE-4' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2',
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-IP.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-IP record: CLAIM-PYMT-REM-CODE-1, CLAIM-PYMT-REM-CODE-2, CLAIM-PYMT-REM-CODE-3, CLAIM-PYMT-REM-CODE-4' |
|
05/21/2021
|
3.0.0 |
RULE-1343
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DIAGNOSIS-CODE-1, then when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-1 is '1', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-1 should be a valid value in 'ICD-9-DIAGNOSIS-CODE'. when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-1 is '2', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-1 should be a valid value in 'ICD-10-DIAGNOSIS-CODE'.' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DIAGNOSIS-CODE-1,
then when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-1 is '1', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-1 should be a valid value in 'ICD-9-DIAGNOSIS-CODE'. |
|
05/21/2021
|
3.0.0 |
RULE-1347
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DIAGNOSIS-CODE-2, then when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-2 is '1', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-2 should be a valid value in 'ICD-9-DIAGNOSIS-CODE'. when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-2 is '2', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-2 should be a valid value in 'ICD-10-DIAGNOSIS-CODE'.' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DIAGNOSIS-CODE-2,
then when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-2 is '1', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-2 should be a valid value in 'ICD-9-DIAGNOSIS-CODE'.
when CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-FLAG-2 is '2', CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-2 should be a valid value in 'ICD-10-DIAGNOSIS-CODE'.' |
|
05/21/2021
|
3.0.0 |
RULE-1349
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DIAGNOSIS-CODE-2, then CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-1 does not equal CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-2' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DIAGNOSIS-CODE-2,
then CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-1 does not equal CLAIM-HEADER-RECORD-OT.DIAGNOSIS-CODE-2' |
|
05/21/2021
|
3.0.0 |
RULE-1371
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-OT.TYPE-OF-BILL is a valid type of bill code' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-BILL,
then CLAIM-HEADER-RECORD-OT.TYPE-OF-BILL is a valid type of bill code' |
|
05/21/2021
|
3.0.0 |
RULE-1379
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then The values of the following fields should be unique for each CLAIM-HEADER-RECORD-OT record: CLAIM-PYMT-REM-CODE-1, CLAIM-PYMT-REM-CODE-2, CLAIM-PYMT-REM-CODE-3, CLAIM-PYMT-REM-CODE-4' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2',
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.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-OT record: CLAIM-PYMT-REM-CODE-1, CLAIM-PYMT-REM-CODE-2, CLAIM-PYMT-REM-CODE-3, CLAIM-PYMT-REM-CODE-4' |
|
05/21/2021
|
3.0.0 |
RULE-1433
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2',
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'
and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null
then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
05/21/2021
|
3.0.0 |
RULE-1544
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W', then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NPI-NUM
then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2' |
|
05/21/2021
|
3.0.0 |
RULE-1558
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT has a null or invalid value for MEDICARE-BENEFICIARY-IDENTIFIER, then CLAIM-HEADER-RECORD-OT has a valid, non-null value for MEDICARE-HIC-NUM' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1'
and CLAIM-HEADER-RECORD-OT has a null or invalid value for MEDICARE-BENEFICIARY-IDENTIFIER,
then CLAIM-HEADER-RECORD-OT has a valid, non-null value for MEDICARE-HIC-NUM' |
|
05/21/2021
|
3.0.0 |
RULE-1623
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2',
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE
and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE ,
then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE' |
|
05/21/2021
|
3.0.0 |
RULE-1630
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2',
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135'
and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE
then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE' |
|
05/21/2021
|
3.0.0 |
RULE-1632
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and FILE-HEADER-RECORD-OT has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to FILE-HEADER-RECORD-OT.END-OF-TIME-PERIOD' |
if and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2',
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122'
and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and FILE-HEADER-RECORD-OT has a valid, non-null value for END-OF-TIME-PERIOD
then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to FILE-HEADER-RECORD-OT.END-OF-TIME-PERIOD' |
|
05/21/2021
|
3.0.0 |
RULE-1634
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for PROCEDURE-CODE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.PROCEDURE-CODE is a valid value specified by CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG or is a state valid value from 'PROCEDURE-CODE-STATE'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '01', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'CPT'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '02', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'ICD-9-PROCEDURE-CODE'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '06', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'HCPCS'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '07', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'ICD-10-PROCEDURE-CODE'.' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2',
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT has a valid, non-null value for PROCEDURE-CODE
then CLAIM-LINE-RECORD-OT.PROCEDURE-CODE is a valid value specified by CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG or is a state valid value from 'PROCEDURE-CODE-STATE'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '01', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'CPT'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '02', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'ICD-9-PROCEDURE-CODE'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '06', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'HCPCS'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '07', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'ICD-10-PROCEDURE-CODE'.' |
|
05/21/2021
|
3.0.0 |
RULE-1642
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
then if the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
05/21/2021
|
3.0.0 |
RULE-1665
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-OT.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-OT.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number' |
|
05/21/2021
|
3.0.0 |
RULE-1668
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-CLAIM
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NPI-NUM
then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2' |
|
05/21/2021
|
3.0.0 |
RULE-1675
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-NUM' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-NUM' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
05/21/2021
|
3.0.0 |
RULE-1677
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-SURFACE-CODE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-SURFACE-CODE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
05/21/2021
|
3.0.0 |
RULE-2758
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DATE-OF-BIRTH and the first character of CLAIM-LINE-RECORD-OT.TOOTH-NUM is one of 'A' through 'T', then the difference between dates CLAIM-HEADER-RECORD-OT.DATE-OF-BIRTH and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is less than 15 years' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for DATE-OF-BIRTH
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686'
and the first character of CLAIM-LINE-RECORD-OT.TOOTH-NUM is one of 'A' through 'T', then the difference between dates CLAIM-HEADER-RECORD-OT.DATE-OF-BIRTH
and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is less than 15 years' |
|
06/11/2021
|
3.0.0 |
RULE-7537
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if RACE-INFORMATION.RACE is not equal to one of the following: '010', '015',
then RACE-INFORMATION has a null value for RACE-OTHER' |
|
07/02/2021
|
3.0.0 |
RULE-7529
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '2',
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM)
and (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE)
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.IMMIGRATION-STATUS is equal to one of the following: '1', '2', '3' |
|
07/02/2021
|
3.0.0 |
RULE-7538
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ENROLLMENT-TIME-SPAN has a non-null value for MSIS-IDENTIFICATION-NUM
then for every record of type ENROLLMENT-TIME-SPAN, there must be a valid record of type PRIMARY-DEMOGRAPHICS that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM)
and ENROLLMENT-TIME-SPAN.ENROLLMENT-EFF-DATE is greater than or equal to PRIMARY-DEMOGRAPHICS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE
and ENROLLMENT-TIME-SPAN.ENROLLMENT-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE |
|
07/02/2021
|
3.0.0 |
RULE-7539
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ENROLLMENT-TIME-SPAN has a non-null value for MSIS-IDENTIFICATION-NUM
then for every record of type ENROLLMENT-TIME-SPAN, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM)
and (ENROLLMENT-TIME-SPAN.ENROLLMENT-EFF-DATE is greater than or equal to VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE
and ENROLLMENT-TIME-SPAN.ENROLLMENT-END-DATE is less than or equal to VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE) |
|
07/02/2021
|
3.0.0 |
RULE-7540
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ENROLLMENT-TIME-SPAN has a non-null value for MSIS-IDENTIFICATION-NUM
then for every record of type ENROLLMENT-TIME-SPAN, there must be a valid record of type ELIGIBLITY-DETERMINANTS that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-Num)
and ELIGIBLITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
and (ENROLLMENT-TIME-SPAN.ENROLLMENT-EFF-DATE >= ELIGIBLITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE
and ENROLLMENT-TIME-SPAN.ENROLLMENT-END-DATE <= ELIGIBLITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) |
|
06/11/2021
|
3.0.0 |
RULE-7452
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '1'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C',
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR is equal to '1'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
then (CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for MEDICARE-PAID-AMT
and CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT not equal to '0.00')
or (CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT
and CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT not equal to '0.00')
or (CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT
and CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00') |
|
06/11/2021
|
3.0.0 |
RULE-7453
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '1'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C',
then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT' |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR is equal to '1'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
then (CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for MEDICARE-PAID-AMT
and CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT not equal to '0.00')
or (CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT
and CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT not equal to '0.00')
or (CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT
and CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00') |
|
06/11/2021
|
3.0.0 |
RULE-7454
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C',
then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C',
then (CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT not equal to '0.00')
or (CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT
and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT not equal to '0.00')
or (CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT
and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00') |
|
06/11/2021
|
3.0.0 |
RULE-7455
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then CLAIM-LINE-RECORD-RX has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4'
and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR is equal to '1'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C'
then (CLAIM-LINE-RECORD-RX has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT not equal to '0.00')
or (CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT
and CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT not equal to '0.00')
or (CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT
and CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00') |
|
07/15/2022
|
3.0.1 |
RULE-7550
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-IP.1115A-DEMONSTRATION-IND equals '1',
then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type 1115A-DEMONSTRATION-INFORMATION that matches on the join keys
and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is greater than or equal to 1115A-DEMONSTRATION-INFORMATION.1115A-EFF-DATE
and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is less than or equal to 1115A-DEMONSTRATION-INFORMATION.1115A-END-DATE
and 1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equals '1' |
|
07/15/2022
|
3.0.1 |
RULE-7551
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-LT.1115A-DEMONSTRATION-IND equals '1',
then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type 1115A-DEMONSTRATION-INFORMATION that matches on the join keys
and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE is greater than or equal to 1115A-DEMONSTRATION-INFORMATION.1115A-EFF-DATE
and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE is less than or equal to 1115A-DEMONSTRATION-INFORMATION.1115A-END-DATE
and 1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equals '1' |
|
07/15/2022
|
3.0.1 |
RULE-7552
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.1115A-DEMONSTRATION-IND equals '1' ,
then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type 1115A-DEMONSTRATION-INFORMATION that matches on the join keys
and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE is greater than or equal to 1115A-DEMONSTRATION-INFORMATION.1115A-EFF-DATE
and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to 1115A-DEMONSTRATION-INFORMATION.1115A-END-DATE
and 1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equals '1' |
|
07/15/2022
|
3.0.1 |
RULE-7549
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.1115A-DEMONSTRATION-IND equals '1' ,
then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type 1115A-DEMONSTRATION-INFORMATION that matches on the join keys
and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is greater than or equal to 1115A-DEMONSTRATION-INFORMATION.1115A-EFF-DATE
and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is less than or equal to 1115A-DEMONSTRATION-INFORMATION.1115A-END-DATE
and 1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equals '1' |
|
07/23/2021
|
3.0.0 |
RULE-7541
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is equal to '686'
then CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '1' |
|
07/23/2021
|
3.0.0 |
RULE-7542
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is equal to '686'
then CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '1' |
|
07/23/2021
|
3.0.0 |
RULE-7543
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is equal to '686'
then CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '1' |
|
07/23/2021
|
3.0.0 |
RULE-7544
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is equal to '686'
then CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '1' |
|
06/11/2021
|
3.0.0 |
RULE-7459
|
UPDATE |
Data Dictionary - Validation Rules |
if WAIVER-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM
and WAIVER-TYPE is equal to one of the following: '02', '03', '04', '05', '06', '07', '08','09', '10', '11, '12', '13', '14', '15', '16', '17', '18','19', '20', '32', '33'
then substr(WAIVER-PARTICIPATION.WAIVER-ID, 1, 2) must be in (A-Z/a-z)
and substr(WAIVER-PARTICIPATION.WAIVER-ID, 3, 1) must be equal to '.'
and substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 7) must be equal to 0-9 digits) |
if WAIVER-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM
and WAIVER-TYPE is equal to one of the following: '02', '03', '04', '05', '06', '07', '08','09', '10', '11, '12', '13', '14', '15', '16', '17', '18','19', '20', '32', '33'
then substr(WAIVER-PARTICIPATION.WAIVER-ID, 1, 2) must be in (A-Z/a-z)
and substr(WAIVER-PARTICIPATION.WAIVER-ID, 3, 1) must be equal to '.'
and substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 4) must be equal to 0-9 digits) |
|
07/02/2021
|
3.0.0 |
RULE-7384
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-IP has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
07/02/2021
|
3.0.0 |
RULE-7385
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-IP has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
07/02/2021
|
3.0.0 |
RULE-7386
|
UPDATE |
Data Dictionary - Validation Rules |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-LT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
07/02/2021
|
3.0.0 |
RULE-7387
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-OT has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
07/02/2021
|
3.0.0 |
RULE-7388
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '4'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01'
then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
|
07/02/2021
|
3.0.0 |
RULE-7389
|
UPDATE |
Data Dictionary - Validation Rules |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
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.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-LT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
07/02/2021
|
3.0.0 |
RULE-7390
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-OT has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
07/02/2021
|
3.0.0 |
RULE-7391
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02', then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1'
and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '02'
then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE |
|
07/02/2021
|
3.0.0 |
RULE-7191
|
UPDATE |
Data Dictionary - Validation Rules |
if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '1', then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys and (ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE), where VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '1', '2' |
if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '1', then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE), where VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '1', '2' |
|
07/02/2021
|
3.0.0 |
RULE-7192
|
UPDATE |
Data Dictionary - Validation Rules |
if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '2', then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys and (ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE), where VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '3' |
if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '2', then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE), where VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '3' |
|
07/23/2021
|
3.0.0 |
RULE-7278
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND equals '0',
then CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-IP.MEDICAID-PAID-AMT values',
where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND equals '0',
and CLAIM-HEADER-RECORD-IP.PAYMENT-LEVEL-IND equals '2',
then CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-IP.MEDICAID-PAID-AMT values'
where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
|
07/23/2021
|
3.0.0 |
RULE-7279
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND equals '0',
then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT values',
where CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND equals '0',
and CLAIM-HEADER-RECORD-LT.PAYMENT-LEVEL-IND equals '2',
then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT values'
where CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
|
07/23/2021
|
3.0.0 |
RULE-7280
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0',
then CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT values',
where CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0',
and CLAIM-HEADER-RECORD-OT.PAYMENT-LEVEL-IND equals '2',
then CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT values'
where CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
|
07/23/2021
|
3.0.0 |
RULE-7281
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0',
then CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-RX.MEDICAID-PAID-AMT values',
where CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'A', '1', 'C', '3'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0',
and CLAIM-HEADER-RECORD-RX.PAYMENT-LEVEL-IND equals '2',
then CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-RX.MEDICAID-PAID-AMT values'
where CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
|
07/23/2021
|
3.0.0 |
RULE-7545
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is equal to '686'
then CLAIM-LINE-RECORD-IP.LINE-ADJUSTMENT-IND is equal to '1' |
|
07/23/2021
|
3.0.0 |
RULE-7546
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is equal to '686'
then CLAIM-LINE-RECORD-LT.LINE-ADJUSTMENT-IND is equal to '1' |
|
07/23/2021
|
3.0.0 |
RULE-7547
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is equal to '686'
then CLAIM-LINE-RECORD-OT.LINE-ADJUSTMENT-IND is equal to '1' |
|
07/23/2021
|
3.0.0 |
RULE-7548
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is equal to '686'
then CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-IND is equal to '1' |
|
09/03/2021
|
3.0.0 |
RULE-1244
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '009', '044', '045', '046', '047', '048', '050', '059', '133', '136', '137', '146' |
‘if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: ‘26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '009', '044', '045', '046', '047', '048', '050', '059', '133', '136', '137', '146', '147’ |
|
09/03/2021
|
3.0.0 |
RULE-1656
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '127', '131', '134', '135', '136', '137', '138', '139', '140', '141', '142', '143', '144' |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', ‘030', ‘031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '127', '131', '134', '135', '136', '137', '138', '139', '140', '141', '142', '143', '144', '147’ |
|
08/13/2021
|
3.0.0 |
RULE-7303
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM
or CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM |
|
08/13/2021
|
3.0.0 |
RULE-7311
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is is not equal to one of the following: '26','026','87','087','542','585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
then CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NPI-NUM |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is is not equal to one of the following: '26','026','87','087','542','585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
then CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NPI-NUM |
|
09/03/2021
|
3.0.0 |
RULE-7305
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NUM |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NUM |
|
09/03/2021
|
3.0.0 |
RULE-7306
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NUM |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NUM |
|
09/03/2021
|
3.0.0 |
RULE-7307
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM |
|
09/03/2021
|
3.0.0 |
RULE-7308
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NUM |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NUM |
|
09/03/2021
|
3.0.0 |
RULE-7208
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C"), then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE' |
|
09/03/2021
|
3.0.0 |
RULE-7209
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', and TYPE-OF-CLAIM in ("1","3","A","C") then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
09/03/2021
|
3.0.0 |
RULE-7210
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', and TYPE-OF-CLAIM in ("1","3","A","C") then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
09/03/2021
|
3.0.0 |
RULE-7211
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.PATIENT-STATUS does not equal '30' and TYPE-OF-CLAIM in ("1","3","A","C"), then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for DISCHARGE-DATE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', and CLAIM-HEADER-RECORD-IP.PATIENT-STATUS does not equal '30' and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for DISCHARGE-DATE' |
|
09/03/2021
|
3.0.0 |
RULE-7212
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C"),
then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4',
and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C',
then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
09/03/2021
|
3.0.0 |
RULE-7213
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C"),
then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4',
and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C',
then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
09/03/2021
|
3.0.0 |
RULE-7214
|
UPDATE |
Data Dictionary - Validation Rules |
IF CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is NOT in (Z)AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is NOT in ("26","026","87","087", "542","585", "654", "686")
AND CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C")
THEN CLAIM-HEADER-RX.PRESCRIPTION-FILL-DATE must have a valid, non-null and not invalidly formatted value |
IF CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is NOT in (Z)AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: "26","026","87","087", "542","585", "654"
AND CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4',
and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C'
THEN CLAIM-HEADER-RX.PRESCRIPTION-FILL-DATE must have a valid, non-null and not invalidly formatted value |
|
09/03/2021
|
3.0.0 |
RULE-7252
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C"),
then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4',
and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C',
then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
09/03/2021
|
3.0.0 |
RULE-7253
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C"),
then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4',
and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C',
then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
09/03/2021
|
3.0.0 |
RULE-7215
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C","2","B"),
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4',
and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', '2', 'B',
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
09/03/2021
|
3.0.0 |
RULE-7216
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C","2","B"),
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4',
and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', '2', 'B',
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
09/03/2021
|
3.0.0 |
RuLE-7217
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C","2","B"),
then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4',
and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', '2', 'B',
then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
09/03/2021
|
3.0.0 |
RULE-7218
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and TYPE-OF-CLAIM in ("1","3","A","C","2","B")
then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4',
and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', '2', 'B',
then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
10/15/2021
|
3.0.0 |
RULE-7254
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' then CLAIM-HEADER-RECORD-IP has a non-null value for TYPE-OF-CLAIM' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-IP has a non-null value for TYPE-OF-CLAIM' |
|
10/15/2021
|
3.0.0 |
RULE-7255
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' then CLAIM-HEADER-RECORD-LT has a non-null value for TYPE-OF-CLAIM' |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-LT has a non-null value for TYPE-OF-CLAIM' |
|
10/15/2021
|
3.0.0 |
RULE-7256
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-CLAIM' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-CLAIM' |
|
10/15/2021
|
3.0.0 |
RULE-7257
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' then CLAIM-HEADER-RECORD-RX has a non-null value for TYPE-OF-CLAIM' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-RX has a non-null value for TYPE-OF-CLAIM' |
|
10/15/2021
|
3.0.0 |
RULE-7258
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to "0" or "4"and TYPE-OF-CLAIM in ("1","3","A","C")then CLAIM-LINE-RECORD-IP has a non-null value for TYPE-OF-SERVICE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to "0" or "4"and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-IP has a non-null value for TYPE-OF-SERVICE' |
|
10/15/2021
|
3.0.0 |
RULE-7259
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0" or "4"and TYPE-OF-CLAIM in ("1","3","A","C") then CLAIM-LINE-RECORD-LT has a non-null value for TYPE-OF-SERVICE' |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0" or "4" and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-LT has a non-null value for TYPE-OF-SERVICE' |
|
10/15/2021
|
3.0.0 |
RULE-7260
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" or "4"and TYPE-OF-CLAIM in ("1","3","A","C") then CLAIM-LINE-RECORD-OT has a non-null value for TYPE-OF-SERVICE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" or "4" and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-OT has a non-null value for TYPE-OF-SERVICE' |
|
10/15/2021
|
3.0.0 |
RULE-7261
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0" or "4"and TYPE-OF-CLAIM in ("1","3","A","C")then CLAIM-LINE-RECORD-RX has a non-null value for TYPE-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0" or "4" and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-RX has a non-null value for TYPE-OF-SERVICE' |
|
10/15/2021
|
3.0.0 |
RULE-7262
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to "0" or "4"and TYPE-OF-CLAIM in ("1","A") then CLAIM-LINE-RECORD-IP has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to "0" or "4" and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-IP has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
|
10/15/2021
|
3.0.0 |
RULE-7263
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0" or "4"and TYPE-OF-CLAIM in ("1","A")then CLAIM-LINE-RECORD-LT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to "0" or "4" and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-LT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
|
10/15/2021
|
3.0.0 |
RULE-7264
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" or "4"and TYPE-OF-CLAIM in ("1","A","2","B") then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal ‘0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal ‘Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to "0" or "4" and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '2’, 'B’, then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
|
10/15/2021
|
3.0.0 |
RULE-7265
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0" or "4" and TYPE-OF-CLAIM in ("1","A")then CLAIM-LINE-RECORD-RX has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0" or "4" and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-RX has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
|
09/03/2021
|
3.0.0 |
RULE-7459
|
UPDATE |
Data Dictionary - Validation Rules |
if WAIVER-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM and WAIVER-TYPE is equal to one of the following: '02', '03', '04', '05', '06', '07', '08','09', '10', '11, '12', '13', '14', '15', '16', '17', '18','19', '20', '32', '33' then substr(WAIVER-PARTICIPATION.WAIVER-ID, 1, 2) must be in (A-Z/a-z) and substr(WAIVER-PARTICIPATION.WAIVER-ID, 3, 1) must be equal to '.' and substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 4) must be equal to 0-9 digits) |
if WAIVER-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM and WAIVER-TYPE is equal to one of the following: '02', '03', '04', '05', '06', '07', '08','09', '10', '11, '12', '13', '14', '15', '16', '17', '18','19', '20', '32', '33' then substr(WAIVER-PARTICIPATION.WAIVER-ID, 1, 2) must be in (A-Z/a-z) and substr(WAIVER-PARTICIPATION.WAIVER-ID, 3, 1) must be equal to '.' and (substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 4) must be equal to 0-9 digits or substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 5) must be equal to 0-9 digits) |
|
09/03/2021
|
3.0.0 |
RULE-7473
|
UPDATE |
Data Dictionary - Validation Rules |
'if PROV-IDENTIFIERS has a non-null value for PROV-IDENTIFIER
and PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2',
then PROV-IDENTIFIERS.PROV-IDENTIFIER is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
and PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE is greater than or equal to "Provider Enumeration Date" from the NPPES NPI data file |
N/A |
|
10/15/2021
|
3.0.0 |
RULE-7301
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal ‘F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686’ and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM |
|
10/15/2021
|
3.0.0 |
RULE-7309
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal ‘F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal ‘0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686’ and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686’ and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NPI-NUM |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NPI-NUM |
|
10/15/2021
|
3.0.0 |
RULE-7302
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686’ and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM |
|
10/15/2021
|
3.0.0 |
RULE-7310
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal ‘Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686’ and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686’ and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NPI-NUM |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', then CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NPI-NUM |
|
10/15/2021
|
3.0.0 |
RULE-7304
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal ‘F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686’ and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM |
|
10/15/2021
|
3.0.0 |
RULE-7312
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal ‘F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654', '686’ and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI |
|
10/15/2021
|
3.0.0 |
RULE-7553
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to '01',
then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP is equal to '23' |
|
10/15/2021
|
3.0.0 |
RULE-7554
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to '05',
then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP is equal to '24' |
|
10/15/2021
|
3.0.0 |
RULE-7555
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to '03',
then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP is equal to '25' |
|
10/15/2021
|
3.0.0 |
RULE-7556
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to '06',
then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP is equal to '26' |
|
11/05/2021
|
3.0.0 |
RULE-7459
|
UPDATE |
Data Dictionary - Validation Rules |
if WAIVER-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUMand WAIVER-TYPE is equal to one of the following: '02', '03', '04', '05', '06', '07', '08','09', '10', '11, '12', '13', '14', '15', '16', '17', '18','19', '20', '32', '33' then substr(WAIVER-PARTICIPATION.WAIVER-ID, 1, 2) must be in (A-Z/a-z) and substr(WAIVER-PARTICIPATION.WAIVER-ID, 3, 1) must be equal to '.' and (substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 4) must be equal to 0-9 digits or substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 5) must be equal to 0-9 digits) |
if WAIVER-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM and WAIVER-TYPE is equal to one of the following: '02', '03', '04', '05', '06', '07', '08','09', '10', '11, '12', '13', '14', '15', '16', '17', '18','19', '20', '32', '33' then substr(WAIVER-PARTICIPATION.WAIVER-ID, 1, 2) must be in (A-Z/a-z) and substr(WAIVER-PARTICIPATION.WAIVER-ID, 3, 1) must be equal to '.' and (substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 4) must be equal to 0-9 digits or substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 5) must be equal to 0-9 digits) or substr(WAIVER-PARTICIPATION.WAIVER-ID, 4, 2) must be equal to 0-9 digits) |
|
11/05/2021
|
3.0.0 |
RULE-7557
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CITIZENSHIP-IND equals '1',
then VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for CITIZENSHIP-VERIFICATION-FLAG' |
|
11/05/2021
|
3.0.0 |
RULE-7559
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10',
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE,
then VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-BENEFICIARY-IDENTIFIER
or VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-HIC-NUM |
|
11/05/2021
|
3.0.0 |
Rule-7558
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBLE-CONTACT-INFORMATION.MSIS-IDENTIFICATION-NUM has a non-null value, then ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-PHONE-NUM' |
|
11/05/2021
|
3.0.0 |
RULE-7560
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
then CLAIM-LINE-RECORD-IP has a null value for MEDICAID-PAID-AMT or CLAIM-LINE-RECORD-IP.MEDICAID-PAID-AMT equals '0.00'' |
|
11/05/2021
|
3.0.0 |
RULE-7561
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
then CLAIM-LINE-RECORD-LT has a null value for MEDICAID-PAID-AMT or CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT equals '0.00'' |
|
11/05/2021
|
3.0.0 |
RULE-7562
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
then CLAIM-LINE-RECORD-OT has a null value for MEDICAID-PAID-AMT or CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT equals '0.00'' |
|
11/05/2021
|
3.0.0 |
RULE-7563
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
then CLAIM-LINE-RECORD-RX has a null value for MEDICAID-PAID-AMT or CLAIM-LINE-RECORD-RX.MEDICAID-PAID-AMT equals '0.00'' |
|
10/15/2021
|
3.0.0 |
Rule-7564
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and substr(CLAIM-LINE-RECORD-OT.PROCEDURE-CODE,1,1) is equal to 'D' and CLAIM-HEADER-RECORD-OT has a non-null value for DIAGNOSIS-CODE-FLAG-1,then CLAIM-HEADER-RECORD-OT has a non-null value for DIAGNOSIS-CODE-1 |
|
11/05/2021
|
3.0.0 |
RULE-7569
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PROV-ATTRIBUTES-MAIN has a non-null value for SUBMITTING-STATE-PROV-ID
and PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03',
then there is no more than one PROV-IDENTIFIERS segment with matching join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2' |
|
11/05/2021
|
3.0.0 |
Rule-7565
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
then CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICAID-PAID-AMT
or CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT equals '0.00'' |
|
11/05/2021
|
3.0.0 |
Rule-7566
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
then CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICAID-PAID-AMT
or CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT equals '0.00'' |
|
11/05/2021
|
3.0.0 |
Rule-7567
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
then CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICAID-PAID-AMT
or CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT equals '0.00'' |
|
11/05/2021
|
3.0.0 |
Rule-7568
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
then CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICAID-PAID-AMT
or CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT equals '0.00'' |
|
12/03/2021
|
3.0.0 |
RULE-7570
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY equals 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR equals '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM equals 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is equal to one of the following: '26', '87', '542', '585', '654',
then for every record of type CLAIM-HEADER-RECORD-IP,
there must be a valid record of type CLAIM-LINE-RECORD-IP that matches on the join keys |
|
12/03/2021
|
3.0.0 |
RULE-7571
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY equals 'F2'
and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR equals '0'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM equals 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is equal to one of the following: '26', '87', '542', '585', '654',
then for every record of type CLAIM-HEADER-RECORD-LT,
there must be a valid record of type CLAIM-LINE-RECORD-LT that matches on the join keys |
|
12/03/2021
|
3.0.0 |
RULE-7572
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY equals 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR equals '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM equals 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is equal to one of the following: '26', '87', '542', '585', '654',
then for every record of type CLAIM-HEADER-RECORD-OT,
there must be a valid record of type CLAIM-LINE-RECORD-OT that matches on the join keys |
|
12/03/2021
|
3.0.0 |
RULE-7573
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY equals 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR equals '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM equals 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is equal to one of the following: '26', '87', '542', '585', '654',
then for every record of type CLAIM-HEADER-RECORD-RX,
there must be a valid record of type CLAIM-LINE-RECORD-RX that matches on the join keys |
|
02/18/2022
|
3.0.0 |
RULE-7168
|
UPDATE |
Data Dictionary - Validation Rules |
if MANAGED-CARE-MAIN.MANAGED-CARE-SERVICE-AREA equals '2' and MANAGED-CARE-SERVICE-AREA has a valid, non-null value for MANAGED-CARE-SERVICE-AREA-NAME, then If the field is populated, the value must be contained in the set of valid values with id: 'COUNTY' and (if MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE is non-null then MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE >= Valid Values Effective-Date and MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE <= Valid Values End-Date) |
if MANAGED-CARE-MAIN.MANAGED-CARE-SERVICE-AREA equals '2' and MANAGED-CARE-SERVICE-AREA has a valid, non-null value for MANAGED-CARE-SERVICE-AREA-NAME, then
if the length(MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-NAME) = 5, the value must be contained in the set of valid values with id: 'COUNTY' Else if the Length (MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-NAME) = 3 then CONCAT(MANAGED-CARE-MAIN.SUBMITTING-STATE, MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-NAME)the value must be contained in the set of valid values with id: 'COUNTY'
and (if MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE is non-null then MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE >= Valid Values Effective-Date and MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE <= Valid Values End-Date)' |
|
12/17/2021
|
3.0.0 |
RULE-7574
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654',
then record CLAIM-LINE-RECORD-IP has corresponding parent record CLAIM-HEADER-RECORD-IP |
|
12/17/2021
|
3.0.0 |
RULE-7575
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654',
then record CLAIM-LINE-RECORD-LT has corresponding parent record CLAIM-HEADER-RECORD-LT |
|
12/17/2021
|
3.0.0 |
RULE-7576
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654',
then record CLAIM-LINE-RECORD-OT has corresponding parent record CLAIM-HEADER-RECORD-OT |
|
12/17/2021
|
3.0.0 |
RULE-7577
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is equal to one of the following: '26', '87', '542', '585', '654',
then record CLAIM-LINE-RECORD-RX has corresponding parent record CLAIM-HEADER-RECORD-RX |
|
12/03/2021
|
3.0.0 |
RULE-7578
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Records with the same primary keys (excluding any date fields) and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' must have non-overlapping date ranges. Effective date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE |
|
12/03/2021
|
3.0.0 |
RULE-7409
|
UPDATE |
Data Dictionary - Validation Rules |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '2'and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01’and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '07','31','61' |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '2'and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to ‘2015-01-01’and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND = '1’ and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '07','31','61' |
|
12/03/2021
|
3.0.0 |
RULE-7410
|
UPDATE |
Data Dictionary - Validation Rules |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '3' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’ then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM) and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)) and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01’ and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '61','62','63','64','65','66','67','68' |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '3'and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’ then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM) and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)) and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to ‘2015-01-01’ and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND = '1 and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '61','62','63','64','65','66','67','68' |
|
12/03/2021
|
3.0.0 |
RULE-7422
|
UPDATE |
Data Dictionary - Validation Rules |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1'and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01' then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01’and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is not equal to one of the following: '61','62','63','64','65','66','67','68' |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1'and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’ then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01’and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND = '1’and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is not equal to one of the following: '61','62','63','64','65','66','67','68' |
|
05/24/2019
|
2.3.0 |
RULE-971
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X', then CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT equals '0.00'' |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT equals '0.00'' |
|
12/17/2021
|
3.0.0 |
RULE-1656
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', '030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '127', '131', '134', '135', '136', '137', '138', '139', '140', '141', '142', '143', '144', '147'' |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '002', '003', '004', '005', '006', '007', '008', '010', '011', '012', '013', '014', '015', '016', '017', '018', '019', '020', '021', '022', '023', '024', '025', '026', '027', '028', '029', ‘030', '031', '032', '035', '036', '037', '038', '039', '040', '041', '042', '043', '049', '050', '051', '052', '053', '054', '055', '056', '057', '058', '060', '061', '062', '063', '064', '065', '066', '067', '068', '069', '070', '071', '072', '073', '074', '075', '076', '077', '078', '079', '080', '081', '082', '083', '084', '085', '086', '087', '088', '089', '115', '119', '120', '121', '122', '127', '131', '134', '135', '136', '137', '138', '139', '140', '141', '142', '143', '144', '145’,'147'' |
|
12/17/2021
|
3.0.0 |
RULE-1938
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '011', '018', '033', '034', '036', '085', '089', '127', '131', '136', '137'' |
‘if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '011', '018', '033', '034', '036', '085', '089', '127', '131', '136', '137', '145’' |
|
12/17/2021
|
3.0.0 |
RULE-7558
|
UPDATE |
Data Dictionary - Validation Rules |
if ELIGIBLE-CONTACT-INFORMATION.MSIS-IDENTIFICATION-NUM has a non-null value, then ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-PHONE-NUM' |
if ELIGIBLE-CONTACT-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM, and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-TYPE equals '01', then ELIGIBLE-CONTACT-INFORMATION has a non-null value for ELIGIBLE-PHONE-NUM' |
|
01/28/2022
|
3.0.0 |
Rule-7579
|
ADD |
Data Dictionary - Validation Rules |
N/A |
‘if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal ‘0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X’, then CLAIM-HEADER-RECORD-IP. MEDICAID-AMOUNT-PAID-DSH is NULL or equal to '0.00’ |
|
01/28/2022
|
3.0.0 |
RULE-7580
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal ‘0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: ‘26', ‘026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to '132’, then CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4','D','X' |
|
01/28/2022
|
3.0.0 |
RULE-7581
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.CLAIM-STATUS is not equal to one of the following: ‘26', ‘026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to '133', then CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X' |
|
01/28/2022
|
3.0.0 |
RULE-7582
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal ‘0' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: ‘26', ‘026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to '134', then CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X' |
|
12/17/2021
|
3.0.0 |
RULE-7553
|
UPDATE |
Data Dictionary - Validation Rules |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '01', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP equals '23'' |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '01' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP equals '23' |
|
12/17/2021
|
3.0.0 |
RULE-7554
|
UPDATE |
Data Dictionary - Validation Rules |
'if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '05', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP equals '24'' |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '05', and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP equals '24'' |
|
12/17/2021
|
3.0.0 |
RULE-7555
|
UPDATE |
Data Dictionary - Validation Rules |
'if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '03', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP equals '25'' |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '03' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP equals '25' |
|
12/17/2021
|
3.0.0 |
RULE-7556
|
UPDATE |
Data Dictionary - Validation Rules |
'if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '06', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP equals '26'' |
if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '06' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP equals '26'' |
|
04/01/2022
|
3.0.0 |
RULE-7633
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to 'Z'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'
then CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' |
|
04/01/2022
|
3.0.0 |
RULE-7634
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM is not equal to 'Z'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'
then CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' |
|
04/01/2022
|
3.0.0 |
RULE-7635
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to 'Z'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654',
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654',
then CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' |
|
04/01/2022
|
3.0.0 |
RULE-7636
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to 'Z'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: ''026', '087’,26', '87', '542', '585', '654'
then CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' |
|
03/11/2022
|
3.0.0 |
RULE-7565
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT equals '0.00'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY equals 'F2' or CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR equals '0' or CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM equals 'Z' or CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT equals '0.00'' |
|
03/11/2022
|
3.0.0 |
RULE-7566
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT equals '0.00'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY equals 'F2' or CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR equals '0' or CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM equals 'Z' or CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT equals '0.00'' |
|
03/11/2022
|
3.0.0 |
RULE-7567
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT equals '0.00'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY equals 'F2' or CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR equals '0' or CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM equals 'Z' or CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT equals '0.00'' |
|
03/11/2022
|
3.0.0 |
RULE-7568
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT equals '0.00'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY equals 'F2' or CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR equals '0' or CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM equals 'Z' or CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT equals '0.00'' |
|
04/01/2022
|
3.0.0 |
RULE-7587
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE-PROV-ID equal to a non-null value and PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE is equal to one of the following values: '01', '02'
then for every record of type PROV-ATTRIBUTES-MAIN, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys (SUBMITTING-STATE, SUBMITTING-STATE-PROV-ID)
and PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2'
and PROV-IDENTIFIERS.PROV-IDENTIFIER is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
and the "Entity Type Code" is equal to '2' in the NPPES data file. |
|
04/01/2022
|
3.0.0 |
RULE-7589
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE-PROV-ID equal to a non-null value
and PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE is equal to '03'
then for every record of type PROV-ATTRIBUTES-MAIN, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys (SUBMITTING-STATE, SUBMITTING-STATE-PROV-ID)
and PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2'
and PROV-IDENTIFIERS.PROV-IDENTIFIER is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
and the "Entity Type Code" is equal to '1' in the NPPES data file. |
|
04/01/2022
|
3.0.0 |
RULE-7593
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal ‘0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: ‘26', ‘026', ‘87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', 'V’
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE has a non-null value
and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to the one of following: '119’, '120', '121', '122', '138’,'139’, '140’, '141’, '142’, '143’, '144’ |
|
06/24/2022
|
3.0.0 |
Rule-7590
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be compatible with specified T-MSIS picture format: X(3) |
|
06/24/2022
|
3.0.0 |
Rule-7591
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be compatible with specified T-MSIS picture format: 9(3) |
|
06/24/2022
|
3.0.0 |
Rule-7592
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be compatible with specified T-MSIS picture format: X(25) |
|
03/11/2022
|
3.0.0 |
RULE-2382
|
UPDATE |
Data Dictionary - Validation Rules |
If MANAGED-CARE-PARTICIPATION has a non-null value for MANAGED-CARE-PLAN-ID
then for every record of type MANAGED-CARE-PARTICIPATION, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys
and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is greater than or equal to MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE
and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is less than or equal to MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE |
If MANAGED-CARE-PARTICIPATION has a non-null value for MANAGED-CARE-PLAN-ID
and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN- ENROLLMENT-END-DATE is greater than or equal to ‘cutover date'
then for every record of type MANAGED-CARE-PARTICIPATION, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and MAX(MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, 'cutover date’) is greater than or equal to MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is less than or equal to MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE |
|
03/11/2022
|
3.0.0 |
RULE-2384
|
UPDATE |
Data Dictionary - Validation Rules |
if MANAGED-CARE-PARTICIPATION has a valid, non-null value for ENROLLED-MANAGED-CARE-PLAN-TYPE and MANAGED-CARE-MAIN has a valid, non-null value for MANAGED-CARE-PLAN-TYPE, then MANAGED-CARE-PARTICIPATION.ENROLLED-MANAGED-CARE-PLAN-TYPE equals MANAGED-CARE-MAIN.MANAGED-CARE-PLAN-TYPE' |
if MANAGED-CARE-PARTICIPATION has a valid, non-null value for ENROLLED-MANAGED-CARE-PLAN-TYPE
and MANAGED-CARE-MAIN has a valid, non-null value for MANAGED-CARE-PLAN-TYPE,
and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN- ENROLLMENT-END-DATE is greater than or equal to ‘cutover date'
then MANAGED-CARE-PARTICIPATION.ENROLLED-MANAGED-CARE-PLAN-TYPE equals MANAGED-CARE-MAIN.MANAGED-CARE-PLAN-TYPE' and MAX(MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, 'cutover date’) is greater than or equal to MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is less than or equal to MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE |
|
01/28/2022
|
3.0.0 |
RULE-7191
|
UPDATE |
Data Dictionary - Validation Rules |
if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '1',
then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
and (ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE),
where VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '1', '2' |
if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '1',
then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
and (MAX(ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE, null) >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE
and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE),
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '1', '2' |
|
01/28/2022
|
3.0.0 |
RULE-7192
|
UPDATE |
Data Dictionary - Validation Rules |
if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '2',
then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
and (ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE),
where VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '3' |
if ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE equals '2',
then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
and (MAX(ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE, null) >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE
and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE),
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '3' |
|
01/28/2022
|
3.0.0 |
RULE-7409
|
UPDATE |
Data Dictionary - Validation Rules |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '2'and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01’and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '07','31','61' |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '2'
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’
then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)
and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to ‘2015-01-01’
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND = '1’
and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '07','31','61' |
|
01/28/2022
|
3.0.0 |
RULE-7410
|
UPDATE |
Data Dictionary - Validation Rules |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '3'and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01’and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '61','62','63','64','65','66','67','68' |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '3'
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’
then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)
and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to ‘2015-01-01’
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND = '1’
and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is equal to one of the following: '61','62','63','64','65','66','67','68' |
|
01/28/2022
|
3.0.0 |
RULE-7422
|
UPDATE |
Data Dictionary - Validation Rules |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1'and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY. MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)) and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01’and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is not equal to one of the following: '61','62','63','64','65','66','67','68' |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1'
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to '2015-01-01’
then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY (there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE, VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MSIS-IDENTIFICATION-NUM with ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE, ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM)
and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,'2015-01-01') is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE))
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01’and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND = '1’
and ELIGIBILITY-DETERMINANTS.ELIGBILITY-GROUP is not equal to one of the following: '61','62','63','64','65','66','67','68' |
|
01/28/2022
|
3.0.0 |
RULE-7427
|
UPDATE |
Data Dictionary - Validation Rules |
if WAIVER-PARTICIPATION.WAIVER-TYPE is equal to '24',
then for every record of type WAIVER-PARTICIPATION, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM),
and (WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE >= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE
and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE <= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE),
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to '6' |
if WAIVER-PARTICIPATION.WAIVER-TYPE equals '24',
then for every record of type WAIVER-PARTICIPATION, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys
and (MAX(WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE, null) >= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE
and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE <= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE),
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1'
and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '6' |
|
01/28/2022
|
3.0.0 |
RULE-7428
|
UPDATE |
Data Dictionary - Validation Rules |
if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to 'C',
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM)
and (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE),
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '3' |
f ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals 'C'
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1',
then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
and (MAX(ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, null) >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE),
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals '3' |
|
01/28/2022
|
3.0.0 |
RULE-7429
|
UPDATE |
Data Dictionary - Validation Rules |
if MFP-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM
then for every record of type MFP-INFORMATION, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM)
and (MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE
and MFP-INFORMATION.MFP-ENROLLMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE),
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to 'D' |
if MFP-INFORMATION has a non-null value for MSIS-IDENTIFICATION-NUM,
then for every record of type MFP-INFORMATION, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys
and (MAX(MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE, null) >= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE
and MFP-INFORMATION.MFP-ENROLLMENT-END-DATE <= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE),
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1'
and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals 'D' |
|
01/28/2022
|
3.0.0 |
RULE-7430
|
UPDATE |
Data Dictionary - Validation Rules |
if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to 'D'
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type MFP-INFORMATION that matches on the join keys
(ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE >= MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE) |
if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals 'D'
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1',
then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
and (MAX(ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, null) >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE) |
|
01/28/2022
|
3.0.0 |
RULE-7529
|
UPDATE |
Data Dictionary - Validation Rules |
if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '2',
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM)
and (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE)
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.IMMIGRATION-STATUS is equal to one of the following: '1', '2', '3' |
if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '2'
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1',
then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
and (MAX(ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, null) >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE
and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE),
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.IMMIGRATION-STATUS is equal to one of the following: '1', '2', '3' |
|
01/28/2022
|
3.0.0 |
RULE-7538
|
UPDATE |
Data Dictionary - Validation Rules |
if ENROLLMENT-TIME-SPAN has a non-null value for MSIS-IDENTIFICATION-NUM
then for every record of type ENROLLMENT-TIME-SPAN, there must be a valid record of type PRIMARY-DEMOGRAPHICS that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM)
and ENROLLMENT-TIME-SPAN.ENROLLMENT-EFF-DATE is greater than or equal to PRIMARY-DEMOGRAPHICS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE
and ENROLLMENT-TIME-SPAN.ENROLLMENT-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE |
if ENROLLMENT-TIME-SPAN-SEGMENT has a non-null value for MSIS-IDENTIFICATION-NUM,
then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
and (MAX(ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE, null) >= PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE
and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE) |
|
01/28/2022
|
3.0.0 |
RULE-7539
|
UPDATE |
Data Dictionary - Validation Rules |
if ENROLLMENT-TIME-SPAN has a non-null value for MSIS-IDENTIFICATION-NUM
then for every record of type ENROLLMENT-TIME-SPAN, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM)
and (ENROLLMENT-TIME-SPAN.ENROLLMENT-EFF-DATE is greater than or equal to VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE
and ENROLLMENT-TIME-SPAN.ENROLLMENT-END-DATE is less than or equal to VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE) |
if ENROLLMENT-TIME-SPAN-SEGMENT has a non-null value for MSIS-IDENTIFICATION-NUM,
then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
and (MAX(ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE, null) >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE
and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE) |
|
01/28/2022
|
3.0.0 |
RULE-7540
|
UPDATE |
Data Dictionary - Validation Rules |
if ENROLLMENT-TIME-SPAN has a non-null value for MSIS-IDENTIFICATION-NUM
then for every record of type ENROLLMENT-TIME-SPAN, there must be a valid record of type ELIGIBLITY-DETERMINANTS that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-Num)
and ELIGIBLITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
and (ENROLLMENT-TIME-SPAN.ENROLLMENT-EFF-DATE >= ELIGIBLITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE
and ENROLLMENT-TIME-SPAN.ENROLLMENT-END-DATE <= ELIGIBLITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) |
if ENROLLMENT-TIME-SPAN-SEGMENT has a non-null value for MSIS-IDENTIFICATION-NUM,
then for every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys
and (MAX(ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE, null) >= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE
and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE <= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE),
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' |
|
04/22/2022
|
3.0.0 |
RULE-2212
|
UPDATE |
Data Dictionary - Validation Rules |
For every record of type HEALTH-HOME-SPA-PROVIDERS, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys |
if HEALTH-HOME-SPA-PROVIDERS has a non-null value for HEALTH-HOME-SPA-NAMEand HEALTH-HOME-SPA-PROVIDERS.HEALTH-HOME-SPA-PROVIDER-END-DATE is greater than or equal to 'cutover date' then for every record of type HEALTH-HOME-SPA-PROVIDERS, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys and (Max(HEALTH-HOME-SPA-PROVIDERS.HEALTH-HOME-SPA-PROVIDER-EFF-DATE, 'cutover date')) is greater than or equal to PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and HEALTH-HOME-SPA-PROVIDERS.HEALTH-HOME-SPA-PROVIDER-END-DATE is less than or equal to PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE |
|
04/22/2022
|
3.0.0 |
RULE-2258
|
UPDATE |
Data Dictionary - Validation Rules |
For every record of type LOCK-IN-INFORMATION, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys |
if LOCK-IN-INFORMATION has a non-null value for LOCKIN-PROV-NUM and LOCK-IN-INFORMATION.LOCKIN-END-DATE is greater than or equal to 'cutover date' then for every record of type LOCK-IN-INFORMATION, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys and (Max(LOCK-IN-INFORMATION.LOCKIN-EFF-DATE, 'cutover date')) is greater than or equal to PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and LOCK-IN-INFORMATION.LOCKIN-END-DATE is less than or equal to PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE |
|
04/22/2022
|
3.0.0 |
RULE-2357
|
UPDATE |
Data Dictionary - Validation Rules |
For every record of type LTSS-PARTICIPATION, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys |
if LTSS-PARTICIPATION has a non-null value for LTSS-PROV-NUM and LTSS-PARTICIPATION.LTSS-ELIGIBILITY-END-DATE is greater than or equal to 'cutover date' then for every record of type LTSS-PARTICIPATION, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys and (Max(LTSS-PARTICIPATION.LTSS-ELIGIBILITY-EFF-DATE , 'cutover date')) is greater than or equal to PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and LTSS-PARTICIPATION.LTSS-ELIGIBILITY-END-DATE is less than or equal to PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE |
|
04/22/2022
|
3.0.0 |
RULE-2990
|
UPDATE |
Data Dictionary - Validation Rules |
if PROV-AFFILIATED-PROGRAMS.AFFILIATED-PROGRAM-TYPE equals '2', then for every record of type PROV-AFFILIATED-PROGRAMS, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys |
if PROV-AFFILIATED-PROGRAMS.AFFILIATED-PROGRAM-TYPE equals '2',and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-END-DATE is greater than or equal to 'cutover date', then for every record of type PROV-AFFILIATED-PROGRAMS, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and (Max(PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-EFF-DATE, 'cutover date')) is greater than or equal to MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-END-DATE is less than or equal to MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE |
|
04/22/2022
|
3.0.0 |
RULE-3061
|
UPDATE |
Data Dictionary - Validation Rules |
if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a valid, non-null value for INSURANCE-COVERAGE-END-DATE, then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null and not invalidly formatted value for DATE-OF-DEATH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to 'cutover date' and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a non-null value for INSURANCE-COVERAGE-END-DATE, then for every record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY, there must be a valid record of type TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO that matches on the join keys and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH and (MAX(PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE, 'cutover date') is greater than or equal to TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE <= TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-END-DATE) |
|
06/24/2022
|
3.0.0 |
Rule-6703
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4) |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(5) |
|
06/24/2022
|
3.0.0 |
Rule-832
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(6)V999 |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(8)V999 |
|
06/24/2022
|
3.0.0 |
Rule-6152
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4) |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(5) |
|
06/24/2022
|
3.0.0 |
Rule-6661
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(6)V999 |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(8)V999 |
|
06/24/2022
|
3.0.0 |
Rule-6900
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(12) |
Value must be compatible with specified T-MSIS picture format: X(30) |
|
06/24/2022
|
3.0.0 |
Rule-6931
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(12) |
Value must be compatible with specified T-MSIS picture format: X(30) |
|
06/24/2022
|
3.0.0 |
Rule-7594
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid date of the form CCYYMMDD |
|
06/24/2022
|
3.0.0 |
Rule-7595
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid date of the form CCYYMMDD |
|
06/24/2022
|
3.0.0 |
Rule-7596
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then Value must be compatible with specified T-MSIS picture format: X(1) |
|
06/24/2022
|
3.0.0 |
Rule-7610
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then if the field is populated, the value must be contained in the set of valid values with id: 'IHS-SERVICE-IND'
and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date' |
|
06/24/2022
|
3.0.0 |
Rule-7597
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7598
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7599
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7600
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7612
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then Value must be compatible with specified T-MSIS picture format: X(30) |
|
06/24/2022
|
3.0.0 |
Rule-7613
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be compatible with specified T-MSIS picture format: X(10) |
|
06/24/2022
|
3.0.0 |
Rule-7614
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7615
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7616
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V999 |
|
06/24/2022
|
3.0.0 |
Rule-7617
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7618
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then Value must be compatible with specified T-MSIS picture format: X(1) |
|
06/24/2022
|
3.0.0 |
RULE-416
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-417
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-1, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-1' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-429
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-430
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-2, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-2' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-442
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-455
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-456
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-4, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-4' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-469
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-470
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-5, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-5' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-482
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-483
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-6, then CLAIM-HEADER-RECORD-IP has a null or invalid value for PROCEDURE-CODE-MOD-6' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-518
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ALLOWED-CHARGE-SRC' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-537
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6150
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6284
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6286
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6287
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6302
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6303
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6304
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6561
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6607
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(10) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6652
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(1) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6707
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6826
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6893
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-7046
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(10) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-705
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2',
then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null
then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-7055
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-706
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-707
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-7079
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(10) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-720
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: S9(5)V9 |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-751
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for UNDER-DIRECTION-OF-PROV-NPI, then CLAIM-HEADER-RECORD-IP.UNDER-DIRECTION-OF-PROV-NPI is a valid National Provider Identifier (NPI) number' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-753
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-754
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for UNDER-SUPERVISION-OF-PROV-NPI, then CLAIM-HEADER-RECORD-IP.UNDER-SUPERVISION-OF-PROV-NPI is a valid National Provider Identifier (NPI) number' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-756
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-801
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-814
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
Rule-1653
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999 |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(8)V999 |
|
06/24/2022
|
3.0.0 |
Rule-1716
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(6)V999 |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: S9(8)V999 |
|
06/24/2022
|
3.0.0 |
Rule-6183
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999 |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(8)V999 |
|
06/24/2022
|
3.0.0 |
Rule-7027
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4) |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(5) |
|
06/24/2022
|
3.0.0 |
Rule-7605
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7606
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7607
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7608
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7609
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then Value must be compatible with specified T-MSIS picture format: X(1) |
|
06/24/2022
|
3.0.0 |
Rule-7620
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7621
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7622
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7623
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7624
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7625
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be compatible with specified T-MSIS picture format: X(1) |
|
06/24/2022
|
3.0.0 |
Rule-7626
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7627
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7628
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7629
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
|
06/24/2022
|
3.0.0 |
Rule-7630
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then Value must be compatible with specified T-MSIS picture format: X(1) |
|
06/24/2022
|
3.0.0 |
RULE-1136
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1137
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and (if CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1138
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and (if CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1182
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for UNDER-DIRECTION-OF-PROV-NPI, then CLAIM-HEADER-RECORD-LT.UNDER-DIRECTION-OF-PROV-NPI is a valid National Provider Identifier (NPI) number' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1183
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1184
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for UNDER-SUPERVISION-OF-PROV-NPI, then CLAIM-HEADER-RECORD-LT.UNDER-SUPERVISION-OF-PROV-NPI is a valid National Provider Identifier (NPI) number' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1185
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1186
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1250
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6180
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6235
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6335
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6413
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6438
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: S9(5)V9 |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6491
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(10) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6553
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-7013
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-7062
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(12) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-976
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1395
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1553
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1554
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '121', '122', then CLAIM-HEADER-RECORD-OT has a null or invalid value for REFERRING-PROV-TAXONOMY' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1555
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1556
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1561
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: S9(5)V9 |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1585
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be a valid date of the form CCYYMMDD |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1594
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for UNDER-DIRECTION-OF-PROV-NPI, then CLAIM-HEADER-RECORD-OT.UNDER-DIRECTION-OF-PROV-NPI is a valid National Provider Identifier (NPI) number' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1595
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1599
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1709
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for HCPCS-RATE, then CLAIM-LINE-RECORD-OT.HCPCS-RATE does not contain any pipe (|) or asterisk (*) characters' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6218
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6336
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(14) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6401
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6632
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6790
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6818
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(10) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6819
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6832
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6854
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(10) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1793
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99 |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1854
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1855
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1856
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-1894
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6171
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(10) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6479
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6542
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6745
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(2) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6924
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(12) |
N/A |
|
03/11/2022
|
3.0.0 |
RULE-7400
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal ‘Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-HEADER-RECORD-IP.SERVICE-TRACKING-PAYMENT-AMT is not equal to '0’ |
|
03/11/2022
|
3.0.0 |
RULE-7401
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT' |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-HEADER-RECORD-LT.SERVICE-TRACKING-PAYMENT-AMT is not equal to '0’ |
|
03/11/2022
|
3.0.0 |
RULE-7402
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-HEADER-RECORD-OT.SERVICE-TRACKING-PAYMENT-AMT is not equal to '0’ |
|
03/11/2022
|
3.0.0 |
RULE-7403
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for SERVICE-TRACKING-PAYMENT-AMT and CLAIM-HEADER-RECORD-RX.SERVICE-TRACKING-PAYMENT-AMT is not equal to '0’ |
|
03/11/2022
|
3.0.0 |
RULE-7522
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT does not equal '0.00'' |
‘if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal ‘F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal ‘0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', '5’, ’6’ and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT does not equal '0.00'' |
|
03/11/2022
|
3.0.0 |
RULE-7523
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT does not equal '0.00'' |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', '5’, ’6’ and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT does not equal '0.00'' |
|
03/11/2022
|
3.0.0 |
RULE-7524
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT does not equal '0.00'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4', '5’, ’6’ and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '5', 'E', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMTand CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT does not equal '0.00'' |
|
03/11/2022
|
3.0.0 |
RULE-7521
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-IP has a non-null value for SERVICE-TRACKING-TYPE' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal ‘0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-IP has a non-null value for SERVICE-TRACKING-TYPE and CLAIM-HEADER-RECORD-IP.SERVICE-TRACKING-TYPE does not equal '0’and CLAIM-HEADER-RECORD-IP.SERVICE-TRACKING-TYPE does not equal '00’ |
|
03/11/2022
|
3.0.0 |
RULE-7404
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-LT has a non-null value for SERVICE-TRACKING-TYPE' |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-LT has a non-null value for SERVICE-TRACKING-TYPE and CLAIM-HEADER-RECORD-LT.SERVICE-TRACKING-TYPE does not equal '0’ and CLAIM-HEADER-RECORD-LT.SERVICE-TRACKING-TYPE does not equal '00’ |
|
03/11/2022
|
3.0.0 |
RULE-7405
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-OT has a non-null value for SERVICE-TRACKING-TYPE' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-OT has a non-null value for SERVICE-TRACKING-TYPE and CLAIM-HEADER-RECORD-OT.SERVICE-TRACKING-TYPE does not equal '0’ and CLAIM-HEADER-RECORD-OT.SERVICE-TRACKING-TYPE does not equal '00’ |
|
03/11/2022
|
3.0.0 |
RULE-7406
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-RX has a non-null value for SERVICE-TRACKING-TYPE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-RX has a non-null value for SERVICE-TRACKING-TYPE and CLAIM-HEADER-RECORD-RX.SERVICE-TRACKING-TYPE does not equal '0’ and CLAIM-HEADER-RECORD-RX.SERVICE-TRACKING-TYPE does not equal '00’ |
|
06/24/2022
|
3.0.0 |
Rule-7611
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then if the field is populated, the value must be contained in the set of valid values with id: 'IHS-SERVICE-IND'
and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value
and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date
and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
06/24/2022
|
3.0.0 |
Rule-7619
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then if the field is populated, the value must be contained in the set of valid values with id: 'IHS-SERVICE-IND'
and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value
and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date
and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
06/24/2022
|
3.0.0 |
Rule-7631
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then if the field is populated, the value must be contained in the set of valid values with id: 'IHS-SERVICE-IND'
and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has a non-null value,
and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date' |
|
06/24/2022
|
3.0.0 |
Rule-7632
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2',
then if the field is populated, the value must be contained in the set of valid values with id: 'PRESCRIPTION-ORIGIN-CODE'
and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has a non-null value,
and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date' |
|
03/11/2022
|
3.0.0 |
RULE-709
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then if and only if CLAIM-HEADER-RECORD-IP.OUTLIER-CODE is equal to one of the following: '01', '02', '10', then CLAIM-HEADER-RECORD-IP has a valid, non-null value for DRG-OUTLIER-AMT' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.OUTLIER-CODE is equal to one of the following: '01', '02', '10', then CLAIM-HEADER-RECORD-IP has a valid, non-null value for DRG-OUTLIER-AMT' |
|
04/01/2022
|
3.0.0 |
RULE-7637
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '5'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is greater than zero
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02',
then CLAIM-LINE-RECORD-IP has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
04/01/2022
|
3.0.0 |
RULE-7638
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', '5'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is greater than zero
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02',
then CLAIM-LINE-RECORD-LT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
04/01/2022
|
3.0.0 |
RULE-7639
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 2', '5'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is greater than zero
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02',
then CLAIM-LINE-RECORD-OT has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
04/01/2022
|
3.0.0 |
RULE-7640
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '5'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is greater than zero
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02',
then CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
|
06/24/2022
|
3.0.0 |
RULE-2388
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE' and (if MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is non-null then MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE >= Valid Values Effective-Date and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6584
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(10) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6966
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(1) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2710
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and (if NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE is non-null then NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE >= Valid Values Effective-Date and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2711
|
UPDATE |
Data Dictionary - Validation Rules |
'if NATIONAL-HEALTH-CARE-ENTITY-ID-INFO has a valid, non-null value for SUBMITTING-STATE and FILE-HEADER-RECORD-MANAGED-CARE has a valid, non-null value for SUBMITTING-STATE, then NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.SUBMITTING-STATE refers to the same state as FILE-HEADER-RECORD-MANAGED-CARE.SUBMITTING-STATE' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2713
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: 9(11) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2714
|
UPDATE |
Data Dictionary - Validation Rules |
Field RECORD-NUMBER should be unique across all records of type NATIONAL-HEALTH-CARE-ENTITY-ID-INFO |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2716
|
UPDATE |
Data Dictionary - Validation Rules |
'if NATIONAL-HEALTH-CARE-ENTITY-ID-INFO has a valid, non-null value for STATE-PLAN-ID-NUM, then NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.STATE-PLAN-ID-NUM does not contain any pipe (|) or asterisk (*) characters' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2720
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE' and (if NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE is non-null then NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE >= Valid Values Effective-Date and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2722
|
UPDATE |
Data Dictionary - Validation Rules |
'if NATIONAL-HEALTH-CARE-ENTITY-ID-INFO has a valid, non-null value for NATIONAL-HEALTH-CARE-ENTITY-NAME, then NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-NAME does not contain any pipe (|) or asterisk (*) characters' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2723
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be a valid date of the form CCYYMMDD |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2725
|
UPDATE |
Data Dictionary - Validation Rules |
'if NATIONAL-HEALTH-CARE-ENTITY-ID-INFO has a valid, non-null value for NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO has a valid, non-null value for NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-END-DATE, then NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE is less than or equal to NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-END-DATE' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2726
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2729
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be a valid date of the form CCYYMMDD |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2733
|
UPDATE |
Data Dictionary - Validation Rules |
'if NATIONAL-HEALTH-CARE-ENTITY-ID-INFO has a valid, non-null value for STATE-NOTATION, then NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.STATE-NOTATION does not contain any pipe (|) or asterisk (*) characters' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2736
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and (if CHPID-SHPID-RELATIONSHIPS.CHPID-SHPID-RELATIONSHIP-EFF-DATE is non-null then CHPID-SHPID-RELATIONSHIPS.CHPID-SHPID-RELATIONSHIP-EFF-DATE >= Valid Values Effective-Date and CHPID-SHPID-RELATIONSHIPS.CHPID-SHPID-RELATIONSHIP-EFF-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2738
|
UPDATE |
Data Dictionary - Validation Rules |
'if CHPID-SHPID-RELATIONSHIPS has a valid, non-null value for SUBMITTING-STATE and FILE-HEADER-RECORD-MANAGED-CARE has a valid, non-null value for SUBMITTING-STATE, then CHPID-SHPID-RELATIONSHIPS.SUBMITTING-STATE refers to the same state as FILE-HEADER-RECORD-MANAGED-CARE.SUBMITTING-STATE' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2740
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: 9(11) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2741
|
UPDATE |
Data Dictionary - Validation Rules |
Field RECORD-NUMBER should be unique across all records of type CHPID-SHPID-RELATIONSHIPS |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2743
|
UPDATE |
Data Dictionary - Validation Rules |
'if CHPID-SHPID-RELATIONSHIPS has a valid, non-null value for STATE-PLAN-ID-NUM, then CHPID-SHPID-RELATIONSHIPS.STATE-PLAN-ID-NUM does not contain any pipe (|) or asterisk (*) characters' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2747
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be a valid date of the form CCYYMMDD |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2749
|
UPDATE |
Data Dictionary - Validation Rules |
'if CHPID-SHPID-RELATIONSHIPS has a valid, non-null value for CHPID-SHPID-RELATIONSHIP-EFF-DATE and CHPID-SHPID-RELATIONSHIPS has a valid, non-null value for CHPID-SHPID-RELATIONSHIP-END-DATE, then CHPID-SHPID-RELATIONSHIPS.CHPID-SHPID-RELATIONSHIP-EFF-DATE is less than or equal to CHPID-SHPID-RELATIONSHIPS.CHPID-SHPID-RELATIONSHIP-END-DATE' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2750
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2752
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be a valid date of the form CCYYMMDD |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-2756
|
UPDATE |
Data Dictionary - Validation Rules |
'if CHPID-SHPID-RELATIONSHIPS has a valid, non-null value for STATE-NOTATION, then CHPID-SHPID-RELATIONSHIPS.STATE-NOTATION does not contain any pipe (|) or asterisk (*) characters' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6114
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(10) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6135
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(10) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6161
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(12) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6228
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(8) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6240
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(1) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6468
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(500) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6631
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(2) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6635
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(12) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6668
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(500) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6749
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(2) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6838
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(10) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-7021
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(50) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-7035
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(8) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-3185
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE' and (if TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE is non-null then TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE >= Valid Values Effective-Date and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE <= Valid Values End-Date)' |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6130
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(1) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6200
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(10) |
N/A |
|
06/24/2022
|
3.0.0 |
RULE-6437
|
UPDATE |
Data Dictionary - Validation Rules |
Value must be compatible with specified T-MSIS picture format: X(50) |
N/A |
|
06/24/2022
|
3.0.0 |
Rule-1934
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999 |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(8)V999 |
|
06/24/2022
|
3.0.0 |
Rule-1935
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999 |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(8)V999 |
|
06/24/2022
|
3.0.0 |
Rule-6935
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(4) |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be compatible with specified T-MSIS picture format: X(5) |
|
06/24/2022
|
3.0.0 |
RULE-1653
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999 |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(8)V999 |
|
06/24/2022
|
3.0.0 |
RULE-6183
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999 |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(8)V999 |
|
06/24/2022
|
3.0.0 |
RULE-1926
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(5)V99 |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(5)V99 |
|
06/24/2022
|
3.0.0 |
RULE-1934
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999 |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(8)V999 |
|
06/24/2022
|
3.0.0 |
RULE-1935
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(6)V999 |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(8)V999 |
|
06/24/2022
|
3.0.0 |
Rule-7357
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-RX has a non-null value for OT-RX-CLAIM-QUANTITY-ACTUAL' |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0'
and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR is equal to '0'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654',
then CLAIM-LINE-RECORD-RX has a non-null value for PRESCRIPTION-QUANTITY-ACTUAL' |
|
06/24/2022
|
3.0.0 |
RULE-2057
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'PRIMARY-LANGUAGE-ENGL-PROF-CODE' and (if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is non-null then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= Valid Values End-Date)' |
'If the field is populated, the value must be contained in the set of valid values with id: 'ENGL-PROF-CODE' and (if VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is non-null then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= Valid Values End-Date)' |
|
06/24/2022
|
3.0.0 |
RULE-2434
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR' and (if RACE-INFORMATION.RACE-DECLARATION-EFF-DATE is non-null then RACE-INFORMATION.RACE-DECLARATION-EFF-DATE >= Valid Values Effective-Date and RACE-INFORMATION.RACE-DECLARATION-EFF-DATE <= Valid Values End-Date)' |
'If the field is populated, the value must be contained in the set of valid values with id: 'AMERICAN-INDIAN-ALASKA-NATIVE-INDICATOR' and (if RACE-INFORMATION.RACE-DECLARATION-EFF-DATE is non-null then RACE-INFORMATION.RACE-DECLARATION-EFF-DATE >= Valid Values Effective-Date and RACE-INFORMATION.RACE-DECLARATION-EFF-DATE <= Valid Values End-Date)' |
|
04/22/2022
|
3.0.0 |
Rule-7569
|
UPDATE |
Data Dictionary - Validation Rules |
if PROV-ATTRIBUTES-MAIN has a non-null value for SUBMITTING-STATE-PROV-ID and PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03', then there is no more than one PROV-IDENTIFIERS segment with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2' |
if PROV-ATTRIBUTES-MAIN has a non-null value for SUBMITTING-STATE-PROV-ID and PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03', then there is no more than one distinct PROV-IDENTIFIER in PROV-IDENTIFIERS segment with matching join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2' |
|
06/24/2022
|
3.0.0 |
RULE-6774
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: X(8) |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be compatible with specified T-MSIS picture format: S9(3)V99999) |
|
05/13/2022
|
3.0.0 |
RULE-7642
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
|
05/13/2022
|
3.0.0 |
RULE-7643
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is not equal to one of the following: '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 for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
|
05/13/2022
|
3.0.0 |
RULE-7644
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to one of the following: '1'and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686',then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
|
05/13/2022
|
3.0.0 |
RULE-7645
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
|
05/13/2022
|
3.0.0 |
RULE-7646
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to one of the following: '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686', then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
|
06/03/2022
|
3.0.0 |
RULE-7647
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C'
then CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND must have a non-null value |
|
06/03/2022
|
3.0.0 |
RULE-7648
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C'
then CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND must have a non-null value |
|
06/03/2022
|
3.0.0 |
RULE-7649
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C'
then CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND must have a non-null value |
|
06/03/2022
|
3.0.0 |
RULE-7650
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C'
then CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND must have a non-null value |
|
06/03/2022
|
3.0.0 |
Rule-7652
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C'
then CLAIM-LINE-RECORD-IP.LINE-ADJUSTMENT-IND must have a non-null value |
|
06/03/2022
|
3.0.0 |
Rule-7653
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C'
then CLAIM-LINE-RECORD-LT.LINE-ADJUSTMENT-IND must have a non-null value |
|
06/03/2022
|
3.0.0 |
Rule-7654
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C'
then CLAIM-LINE-RECORD-OT.LINE-ADJUSTMENT-IND must have a non-null value |
|
06/03/2022
|
3.0.0 |
Rule-7655
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C'
then CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-IND must have a non-null value |
|
06/03/2022
|
3.0.0 |
RULE-7651
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B'
then CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND must have a non-null value' |
|
06/03/2022
|
3.0.0 |
RULE-7656
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B'
then CLAIM-LINE-RECORD-OT.LINE-ADJUSTMENT-IND must have a non-null value' |
|
05/13/2022
|
3.0.0 |
RULE-7633
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to 'Z'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'
then CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to 'Z'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'
then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type CLAIM-LINE-RECORD-IP that matches on join keys
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' |
|
05/13/2022
|
3.0.0 |
RULE-7634
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM is not equal to 'Z'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'
then CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' |
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.TYPE-OF-CLAIM is not equal to 'Z'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654'
then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type CLAIM-LINE-RECORD-LT that matches on join keys
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' |
|
05/13/2022
|
3.0.0 |
RULE-7635
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to 'Z'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654',
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654',
then CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to 'Z'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654',
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654',
then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type CLAIM-LINE-RECORD-OT that matches on join keys
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' |
|
05/13/2022
|
3.0.0 |
RULE-7636
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to 'Z'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: ''026', '087’,26', '87', '542', '585', '654'
then CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to 'Z'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: ''026', '087’,26', '87', '542', '585', '654'
then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type CLAIM-LINE-RECORD-RX that matches on join keys
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '026', '087’,'26', '87', '542', '585', '654' |
|
08/05/2022
|
3.0.1 |
Rule-7641
|
UPDATE |
Data Dictionary - Validation Rules |
if VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MSIS-IDENTIFICATION-NUM and VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-BENEFICIARY-IDENTIFIER or VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-HIC-NUM' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE, then ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10' |
if ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: "01", "02", "03", "04", "05", "06", "08", "09", "10"and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to 'cutover date' and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals "1",then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (MAX(ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, 'cutover date') >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE),and (VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-HIC-NUM or VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-BENEFICIARY-IDENTIFIER) |
|
08/05/2022
|
3.0.1 |
Rule-7677
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-BENEFICIARY-IDENTIFIER or VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-HIC-NUM')and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to ‘cutover date', and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1'then for every record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10'and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE, 'cutover date’) is greater than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is less than or equal to ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE) |
|
06/24/2022
|
3.0.0 |
Rule-7657
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' then (CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-IP has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00') |
|
06/24/2022
|
3.0.0 |
Rule-7658
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' then (CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-LT has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00') |
|
06/24/2022
|
3.0.0 |
Rule-7659
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then (CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00') |
|
06/24/2022
|
3.0.0 |
Rule-7660
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' then (CLAIM-LINE-RECORD-RX has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-RX has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00') |
|
06/24/2022
|
3.0.0 |
Rule-7661
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then (CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT not equal to '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null value and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT not equal to '0.00') |
|
06/24/2022
|
3.0.0 |
Rule-7662
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to '0' or '4'and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '0'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C'then (CLAIM-HEADER-RECORD-IP has a null value for MEDICARE-PAID-AMTor CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT is equal to 0.00)and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-COINS-AMTor CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT is equal to 0.00)and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-DEDUCTIBLE-AMTor CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT is equal to 0.00) |
|
06/24/2022
|
3.0.0 |
Rule-7663
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4'and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0'and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C'then (CLAIM-HEADER-RECORD-LT has a null value for MEDICARE-PAID-AMTor CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT is equal to 0.00)and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-COINS-AMTor CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is equal to 0.00)and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMTor CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT is equal to 0.00) |
|
06/24/2022
|
3.0.0 |
Rule-7664
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C',
then (CLAIM-LINE-RECORD-OT has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT equals '0.00')and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')' |
|
06/24/2022
|
3.0.0 |
Rule-7665
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4'and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C',then (CLAIM-LINE-RECORD-RX has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT equals '0.00')and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')' |
|
06/24/2022
|
3.0.0 |
Rule-7666
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then (CLAIM-LINE-RECORD-OT has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT equals '0.00')and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')' |
|
06/24/2022
|
3.0.0 |
Rule-7667
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)' |
|
06/24/2022
|
3.0.0 |
Rule-7668
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
06/24/2022
|
3.0.0 |
Rule-7669
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
06/24/2022
|
3.0.0 |
Rule-7670
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
06/24/2022
|
3.0.0 |
Rule-7671
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'If CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
06/24/2022
|
3.0.0 |
Rule-7672
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'If CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
06/24/2022
|
3.0.0 |
Rule-7673
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
06/24/2022
|
3.0.0 |
Rule-7674
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then if the LINE-ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
06/24/2022
|
3.0.0 |
Rule-7675
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then if the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
06/24/2022
|
3.0.0 |
Rule-7676
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then if the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
06/24/2022
|
3.0.0 |
RULE-1916
|
UPDATE |
Data Dictionary - Validation Rules |
If the LINE-ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
If the LINE-ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
08/05/2022
|
3.0.1 |
RULE-1259
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (((if CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE is non-null then (CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE <= Valid Values End-Date))
OR
(if CLAIM-HEADER-RECORD-LT.MEDICAID-PAID-DATE is non-null then (CLAIM-HEADER-RECORD-LT.MEDICAID-PAID-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.MEDICAID-PAID-DATE <= Valid Values End-Date)))' |
|
08/05/2022
|
3.0.1 |
RULE-1693
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE'
and (((if CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE is non-null then (CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE <= Valid Values End-Date))
OR
(if CLAIM-HEADER-RECORD-OT.MEDICAID-PAID-DATE is non-null then (CLAIM-HEADER-RECORD-OT.MEDICAID-PAID-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.MEDICAID-PAID-DATE <= Valid Values End-Date)))' |
|
08/05/2022
|
3.0.1 |
RULE-1957
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE'
and (((if CLAIM-LINE-RECORD-RX.ADJUDICATION-DATE is non-null then (CLAIM-LINE-RECORD-RX.ADJUDICATION-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.ADJUDICATION-DATE <= Valid Values End-Date))
OR
(if CLAIM-HEADER-RECORD-RX.MEDICAID-PAID-DATE is non-null then (CLAIM-HEADER-RECORD-RX.MEDICAID-PAID-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.MEDICAID-PAID-DATE <= Valid Values End-Date))) |
|
08/05/2022
|
3.0.1 |
RULE-826
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654',
then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE'
and (((if CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE is non-null then (CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE <= Valid Values End-Date))
OR
(if CLAIM-HEADER-RECORD-IP.MEDICAID-PAID-DATE is non-null then (CLAIM-HEADER-RECORD-IP.MEDICAID-PAID-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.MEDICAID-PAID-DATE <= Valid Values End-Date))) |
|
07/15/2022
|
3.0.1 |
RULE-7678
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4',
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-BILLED-AMT' |
|
07/15/2022
|
3.0.1 |
RULE-7679
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4',
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-BILLED-AMT' |
|
07/15/2022
|
3.0.1 |
RULE-7680
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-BILLED-AMT' |
|
07/15/2022
|
3.0.1 |
RULE-7681
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4',
then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-BILLED-AMT' |
|
07/15/2022
|
3.0.1 |
RULE-7682
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: 'C', '3'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND equals '0'
and CLAIM-HEADER-RECORD-IP.PAYMENT-LEVEL-IND equals '2',
then CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-IP.MEDICAID-PAID-AMT values,
where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
|
07/15/2022
|
3.0.1 |
RULE-7683
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'C', '3'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND equals '0'
and CLAIM-HEADER-RECORD-LT.PAYMENT-LEVEL-IND equals '2',
then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT values,
where CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
|
07/15/2022
|
3.0.1 |
RULE-7684
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'C', '3'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0'
and CLAIM-HEADER-RECORD-OT.PAYMENT-LEVEL-IND equals '2',
then CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT values, where CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
|
07/15/2022
|
3.0.1 |
RULE-7685
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: 'C', '3'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0'
and CLAIM-HEADER-RECORD-RX.PAYMENT-LEVEL-IND equals '2',
then CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-RX.MEDICAID-PAID-AMT values,
where CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'' |
|
07/15/2022
|
3.0.1 |
Rule-7686
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: 'C', '3'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND equals '0'
and CLAIM-HEADER-RECORD-IP has a non-null value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-IP.TOT-ALLOWED-AMT does not equal '0.00'
and CLAIM-HEADER-RECORD-IP has a non-null value for TOT-ALLOWED-AMT,
then CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-IP.TOT-ALLOWED-AMT' |
|
07/15/2022
|
3.0.1 |
Rule-7687
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: 'C', '3'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND equals '0'
and CLAIM-HEADER-RECORD-LT has a non-null value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT does not equal '0.00'
and CLAIM-HEADER-RECORD-LT has a non-null value for TOT-ALLOWED-AMT,
then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT' |
|
07/15/2022
|
3.0.1 |
Rule-7688
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 'C', '3'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0'
and CLAIM-HEADER-RECORD-OT has a non-null value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-OT.TOT-ALLOWED-AMT does not equal '0.00'
and CLAIM-HEADER-RECORD-OT has a non-null value for TOT-ALLOWED-AMT,
then CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-OT.TOT-ALLOWED-AMT' |
|
08/05/2022
|
3.0.1 |
RULE-7201
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to o
ne of the following: 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER,
then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys
and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE) |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W'
and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER,
then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys
and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE) |
|
08/05/2022
|
3.0.1 |
RULE-7200
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER,
then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys
and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE) |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER,
then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys
and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE) |
|
08/05/2022
|
3.0.1 |
RULE-7199
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE) |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W'
and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER,
then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys
and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE) |
|
08/05/2022
|
3.0.1 |
RULE-7198
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V'
and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER,
then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys
and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE) |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W'
and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER,
then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys
and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE) |
|
08/05/2022
|
3.0.1 |
RULE-7197
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
|
08/05/2022
|
3.0.1 |
RULE-7196
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to one of the following: '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
|
08/05/2022
|
3.0.1 |
RULE-7195
|
UPDATE |
Data Dictionary - Validation Rules |
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.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W'and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
|
08/05/2022
|
3.0.1 |
RULE-7194
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W', '2', 'B', 'V' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
|
08/05/2022
|
3.0.1 |
Rule-7701
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', 'V'
and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER,
then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys
and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE) |
|
08/05/2022
|
3.0.1 |
Rule-7702
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', 'V'
and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER,
then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys
and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE) |
|
08/05/2022
|
3.0.1 |
Rule-7703
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', 'V'
and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER,
then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys
and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE) |
|
08/05/2022
|
3.0.1 |
Rule-7704
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', 'V'
and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER,
then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys
and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE) |
|
08/05/2022
|
3.0.1 |
Rule-7705
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '2, 'B', 'V' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
|
08/05/2022
|
3.0.1 |
Rule-7706
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2, 'B', 'V' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
|
08/05/2022
|
3.0.1 |
Rule-7707
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '2, 'B', 'V' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
|
08/05/2022
|
3.0.1 |
Rule-7708
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '2, 'B', 'V' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER, then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION that matches on the join keys and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE must be in (MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE) |
|
08/05/2022
|
3.0.1 |
RULE-7709
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if MANAGED-CARE-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM, and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is greater than or equal to 'cutover date', then for every record of type MANAGED-CARE-PARTICIPATION, there must be a valid record of type ENROLLMENT-TIME-SPAN that matches on the join keys and (MAX(MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, 'cutover date') >= ENROLLMENT-TIME-SPAN.ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE <= ENROLLMENT-TIME-SPAN.ENROLLMENT-END-DATE) |
|
08/26/2022
|
3.0.2 |
Rule-1630
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE, then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal ‘0' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal ‘1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: ‘26', ‘026', ‘87', ‘087', ‘542', ‘585', ‘654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135', '138’, '139’, '140’, '141’, '142’, '143’ and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE, then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE |
|
11/18/2022
|
3.0.5 |
Rule-7770
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a non-null value for WAIVER-TYPE then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type WAIVER-PARTICIPATION that matches on the join keys and (CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is between WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE) and CLAIM-HEADER-RECORD-IP.WAIVER-TYPE is equal to WAIVER-PARTICIPATION.WAIVER-TYPE |
|
11/18/2022
|
3.0.5 |
Rule-7771
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT has a non-null value for WAIVER-TYPE then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type WAIVER-PARTICIPATION that matches on the join keys and (CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE is between WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE) and CLAIM-HEADER-RECORD-LT.WAIVER-TYPE is equal to WAIVER-PARTICIPATION.WAIVER-TYPE |
|
11/18/2022
|
3.0.5 |
Rule-7772
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a non-null value for WAIVER-TYPE then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type WAIVER-PARTICIPATION that matches on the join keys and (CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE is between WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE)and CLAIM-HEADER-RECORD-OT.WAIVER-TYPE is equal to WAIVER-PARTICIPATION.WAIVER-TYPE |
|
11/18/2022
|
3.0.5 |
Rule-7773
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX has a non-null value for WAIVER-TYPE then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type WAIVER-PARTICIPATION that matches on the join keys and (CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is between WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE)and CLAIM-HEADER-RECORD-RX.WAIVER-TYPE is equal to WAIVER-PARTICIPATION.WAIVER-TYPE |
|
08/26/2022
|
3.0.2 |
RULE-1261
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and (((if CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE is non-null then (CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE <= Valid Values End-Date))
OR
(if CLAIM-HEADER-RECORD-LT.MEDICAID-PAID-DATE is non-null then (CLAIM-HEADER-RECORD-LT.MEDICAID-PAID-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.MEDICAID-PAID-DATE <= Valid Values End-Date))) |
|
08/26/2022
|
3.0.2 |
RULE-1695
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE'and (((if CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE is non-nullthen (CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE <= Valid Values End-Date)) OR (if CLAIM-HEADER-RECORD-OT.MEDICAID-PAID-DATE is non-null then (CLAIM-HEADER-RECORD-OT.MEDICAID-PAID-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.MEDICAID-PAID-DATE <= Valid Values End-Date))) |
|
08/26/2022
|
3.0.2 |
RULE-1959
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE'and (((if CLAIM-LINE-RECORD-RX.ADJUDICATION-DATE is non-nullthen (CLAIM-LINE-RECORD-RX.ADJUDICATION-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.ADJUDICATION-DATE <= Valid Values End-Date)) OR (if CLAIM-HEADER-RECORD-RX.MEDICAID-PAID-DATE is non-null then (CLAIM-HEADER-RECORD-RX.MEDICAID-PAID-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.MEDICAID-PAID-DATE <= Valid Values End-Date))) |
|
08/26/2022
|
3.0.2 |
RULE-828
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE'and (((if CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE is non-nullthen (CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ADJUDICATION-DATE <= Valid Values End-Date)) OR (if CLAIM-HEADER-RECORD-IP.MEDICAID-PAID-DATE is non-null then (CLAIM-HEADER-RECORD-IP.MEDICAID-PAID-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.MEDICAID-PAID-DATE <= Valid Values End-Date))) |
|
08/26/2022
|
3.0.2 |
Rule-7710
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE |
|
08/26/2022
|
3.0.2 |
Rule-7711
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE |
|
08/26/2022
|
3.0.2 |
Rule-7712
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE |
|
08/26/2022
|
3.0.2 |
Rule-7713
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE |
|
08/26/2022
|
3.0.2 |
Rule-7719
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE- STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE |
|
08/26/2022
|
3.0.2 |
Rule-7720
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE |
|
08/26/2022
|
3.0.2 |
Rule-7721
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE |
|
08/26/2022
|
3.0.2 |
Rule-7722
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE |
|
08/26/2022
|
3.0.2 |
Rule-7723
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
08/26/2022
|
3.0.2 |
Rule-7724
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
08/26/2022
|
3.0.2 |
Rule-7725
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
|
08/26/2022
|
3.0.2 |
Rule-7726
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
|
08/26/2022
|
3.0.2 |
Rule-7714
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.PATIENT-STATUS does not equal '30' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for DISCHARGE-DATE |
|
08/26/2022
|
3.0.2 |
Rule-7715
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE |
|
08/26/2022
|
3.0.2 |
Rule-7716
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE |
|
08/26/2022
|
3.0.2 |
Rule-7717
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE |
|
08/26/2022
|
3.0.2 |
Rule-7718
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for PRESCRIPTION-FILL-DATE |
|
08/26/2022
|
3.0.2 |
Rule-7729
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PROV-LOCATION-AND-CONTACT-INFO has a non-null value for SUBMITTING-STATE-PROV-ID, then PROV-LOCATION-AND-CONTACT-INFO has a non-null value for ADDR-LN1 |
|
08/26/2022
|
3.0.2 |
Rule-7731
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PROV-LOCATION-AND-CONTACT-INFO has a non-null value for ADDR-LN1, then PROV-LOCATION-AND-CONTACT-INFO has a non-null value for ADDR-CITY |
|
08/26/2022
|
3.0.2 |
Rule-7732
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PROV-LOCATION-AND-CONTACT-INFO has a non-null value for ADDR-LN1, then PROV-LOCATION-AND-CONTACT-INFO has a non-null value for ADDR-STATE |
|
08/26/2022
|
3.0.2 |
Rule-7733
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PROV-LOCATION-AND-CONTACT-INFO has a non-null value for ADDR-LN1, then PROV-LOCATION-AND-CONTACT-INFO has a non-null value for ADDR-ZIP-CODE |
|
08/26/2022
|
3.0.2 |
Rule-7728
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if PROV-ATTRIBUTES-MAIN has a non-null value for SUBMITTING-STATE-PROV-ID
and PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE equals '03,'
then PROV-ATTRIBUTES-MAIN has a non-null value for PROV-LAST-NAME |
|
10/07/2022
|
3.0.3 |
RULE-7737
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-IP has a non-null value for TYPE-OF-SERVICE' |
|
10/07/2022
|
3.0.3 |
RULE-7738
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-LT has a non-null value for TYPE-OF-SERVICE' |
|
10/07/2022
|
3.0.3 |
RULE-7739
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-OT has a non-null value for TYPE-OF-SERVICE' |
|
10/07/2022
|
3.0.3 |
RULE-7740
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-RX has a non-null value for TYPE-OF-SERVICE' |
|
10/07/2022
|
3.0.3 |
RULE-7736
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null value for CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' |
|
10/07/2022
|
3.0.3 |
Rule-7745
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-OT has a non-null value for PLACE-OF-SERVICE and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE |
|
10/07/2022
|
3.0.3 |
Rule-7746
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL or CLAIM-HEADER-RECORD-OT has a non-null value for PLACE-OF-SERVICE |
|
10/07/2022
|
3.0.3 |
Rule-7747
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL, then CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE |
|
10/07/2022
|
3.0.3 |
Rule-7748
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE, then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL |
|
10/07/2022
|
3.0.3 |
Rule-7749
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: ' '3', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODEor CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE |
|
10/07/2022
|
3.0.3 |
Rule-7750
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-RX has a non-null value for DAYS-SUPPLY |
|
10/07/2022
|
3.0.3 |
Rule-7751
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-RX has a non-null value for PRESCRIPTION-QUANTITY-ACTUAL |
|
11/18/2022
|
3.0.5 |
Rule-7768
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals 'G', then ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '03', '06' |
|
10/28/2022
|
3.0.4 |
RULE-7752
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE |
|
10/28/2022
|
3.0.4 |
RULE-7755
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE |
|
10/28/2022
|
3.0.4 |
RULE-7754
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4',then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE |
|
10/28/2022
|
3.0.4 |
RULE-7753
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for MEDICAID-PAID-DATE |
|
11/18/2022
|
3.0.5 |
Rule-7760
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM' |
|
11/18/2022
|
3.0.5 |
Rule-7761
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI' |
|
11/18/2022
|
3.0.5 |
Rule-7762
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM' |
|
11/18/2022
|
3.0.5 |
Rule-7756
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NUM |
|
11/18/2022
|
3.0.5 |
Rule-7757
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NUM |
|
11/18/2022
|
3.0.5 |
Rule-7758
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM |
|
11/18/2022
|
3.0.5 |
Rule-7759
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NUM |
|
11/18/2022
|
3.0.5 |
Rule-7766
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3','C' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM or CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM |
|
11/18/2022
|
3.0.5 |
Rule-7767
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' then CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NPI-NUM or CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NUM |
|
11/18/2022
|
3.0.5 |
Rule-7769
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If the field is populated, the value must be contained in the set of valid values with id: ‘TYPE-OF-SERVICE’ and (if LOCK-IN-INFORMATION.LOCKIN-EFF-DATE is non-null then LOCK-IN-INFORMATION.LOCKIN-EFF-DATE >= Valid Values Effective-Date and LOCK-IN-INFORMATION.LOCKIN-EFF-DATE <= Valid Values End-Date) |
|
11/18/2022
|
3.0.5 |
Rule-7583
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal ‘0'and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: ‘26', ‘026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', D', 'X' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654',then CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is not equal to the one of following: '123’, '135' |
N/A |
|
11/18/2022
|
3.0.5 |
Rule-7585
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal ‘0'and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: ‘26', ‘026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', D', 'X' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654',then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to the one of following: '123’, '131', '135' |
N/A |
|
11/18/2022
|
3.0.5 |
Rule-7586
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal ‘0'and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: ‘26', ‘026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', D', 'X' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654',then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is not equal to '131' |
N/A |
|
11/18/2022
|
3.0.5 |
Rule-7763
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4',
then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM' |
|
11/18/2022
|
3.0.5 |
Rule-7764
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NPI-NUM' |
|
11/18/2022
|
3.0.5 |
Rule-7765
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NPI-NUM' |
|
04/13/2018
|
2.2.0 |
RULE-1658
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does not equal '585' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TOOTH-QUAD-CODE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '013', '029' |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a valid, non-null value for TOOTH-QUAD-CODE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '013', '029', '035' |
|
12/09/2022
|
3.0.6 |
Rule-7774
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then (CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT does not equal '0.00')' |
|
12/09/2022
|
3.0.6 |
Rule-7775
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then (CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT does not equal '0.00')' |
|
12/09/2022
|
3.0.6 |
Rule-7776
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then (CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT does not equal '0.00')' |
|
12/09/2022
|
3.0.6 |
Rule-7777
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4'and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '1'and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A'then (CLAIM-LINE-RECORD-RX has a non-null and not invalidly formatted value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT does not equal '0.00')or (CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT does not equal '0.00')or (CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT does not equal '0.00')' |
|
12/09/2022
|
3.0.6 |
Rule-7778
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then (CLAIM-HEADER-RECORD-IP has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-IP.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00') |
|
12/09/2022
|
3.0.6 |
Rule-7779
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then (CLAIM-HEADER-RECORD-LT has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')' |
|
12/09/2022
|
3.0.6 |
Rule-7780
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then (CLAIM-LINE-RECORD-OT has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-OT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')' |
|
12/09/2022
|
3.0.6 |
Rule-7781
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then (CLAIM-LINE-RECORD-RX has a null value for MEDICARE-PAID-AMT or CLAIM-LINE-RECORD-RX.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-RX has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-RX.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')' |
|
12/09/2022
|
3.0.6 |
RULE-7782
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
|
12/09/2022
|
3.0.6 |
RULE-7783
|
ADD |
Data Dictionary - Validation Rules |
N/A |
f 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.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
|
12/09/2022
|
3.0.6 |
RULE-7784
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to one of the following: '1', then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
|
12/09/2022
|
3.0.6 |
RULE-7785
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
|
12/30/2022
|
3.1.0 |
RULE-7786
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: ''1', 'A'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4',
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for TOT-BILLED-AMT |
|
12/30/2022
|
3.1.0 |
RULE-7787
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4',
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for TOT-BILLED-AMT |
|
12/30/2022
|
3.1.0 |
RULE-7788
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for TOT-BILLED-AMT |
|
12/30/2022
|
3.1.0 |
RULE-7789
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4',
then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-BILLED-AMT |
|
12/30/2022
|
3.1.0 |
RULE-7790
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND equals '0'
and CLAIM-HEADER-RECORD-IP.PAYMENT-LEVEL-IND equals '2',
then CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-IP.MEDICAID-PAID-AMT values,
where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
|
12/30/2022
|
3.1.0 |
RULE-7791
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND equals '0'
and CLAIM-HEADER-RECORD-LT.PAYMENT-LEVEL-IND equals '2',
then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT values,
where CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
|
12/30/2022
|
3.1.0 |
RULE-7792
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0'
and CLAIM-HEADER-RECORD-OT.PAYMENT-LEVEL-IND equals '2',
then CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-OT.MEDICAID-PAID-AMT values,
where CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
|
12/30/2022
|
3.1.0 |
RULE-7793
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0'
and CLAIM-HEADER-RECORD-RX.PAYMENT-LEVEL-IND equals '2',
then CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-RX.MEDICAID-PAID-AMT values,
where CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |
|
12/30/2022
|
3.1.0 |
RULE-7794
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND equals '0'
and CLAIM-HEADER-RECORD-IP has a non-null value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-IP.TOT-ALLOWED-AMT does not equal '0.00'
and CLAIM-HEADER-RECORD-IP has a non-null value for TOT-ALLOWED-AMT,
then CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-IP.TOT-ALLOWED-AMT |
|
12/30/2022
|
3.1.0 |
RULE-7795
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND equals '0'
and CLAIM-HEADER-RECORD-LT has a non-null value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT does not equal '0.00'
and CLAIM-HEADER-RECORD-LT has a non-null value for TOT-ALLOWED-AMT,
then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT |
|
12/30/2022
|
3.1.0 |
RULE-7796
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND equals '0'
and CLAIM-HEADER-RECORD-OT has a non-null value for TOT-MEDICAID-PAID-AMT
and CLAIM-HEADER-RECORD-OT.TOT-ALLOWED-AMT does not equal '0.00'
and CLAIM-HEADER-RECORD-OT has a non-null value for TOT-ALLOWED-AMT,
then CLAIM-HEADER-RECORD-OT.TOT-MEDICAID-PAID-AMT is less than or equal to CLAIM-HEADER-RECORD-OT.TOT-ALLOWED-AMT |
|
12/30/2022
|
3.1.0 |
RULE-7798
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A',
then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE |
|
12/30/2022
|
3.1.0 |
RULE-7797
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A',
then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE |
|
12/30/2022
|
3.1.0 |
RULE-7800
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A',
then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE |
|
12/30/2022
|
3.1.0 |
RULE-7799
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A',
then CLAIM-HEADER-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE |
|
12/30/2022
|
3.1.0 |
RULE-7801
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A',
then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE |
|
12/30/2022
|
3.1.0 |
RULE-7802
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A',
then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE |
|
12/30/2022
|
3.1.0 |
RULE-7803
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A',
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE |
|
12/30/2022
|
3.1.0 |
RULE-7804
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A',
then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE |
|
12/30/2022
|
3.1.0 |
Rule-7805
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-IP.PATIENT-STATUS does not equal '30'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A',
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for DISCHARGE-DATE |
|
12/30/2022
|
3.1.0 |
Rule-7806
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A',
then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for ADMISSION-DATE |
|
12/30/2022
|
3.1.0 |
Rule-7807
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A',
then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE |
|
12/30/2022
|
3.1.0 |
Rule-7808
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A',
then CLAIM-LINE-RECORD-IP has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE |
|
12/30/2022
|
3.1.0 |
Rule-7809
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z'
and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'
and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4'
and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A',
then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for PRESCRIPTION-FILL-DATE |
|
12/30/2022
|
3.1.0 |
RULE-7810
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to 'D'
and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'
then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type MFP-INFORMATION that matches on the join keys
and (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE >= MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= MFP-INFORMATION.MFP-ENROLLMENT-END-DATE) |
|
12/30/2022
|
3.1.0 |
RULE-7430
|
UPDATE |
Data Dictionary - Validation Rules |
if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals 'D'and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1',then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keysand (ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE) |
N/A |
|
01/27/2023
|
3.2.0 |
Rule-7811
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A'and CLAIM-HEADER-RECORD-OT has a non-null value for PLACE-OF-SERVICEand CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE |
|
01/27/2023
|
3.2.0 |
Rule-7812
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL or CLAIM-HEADER-RECORD-OT has a non-null value for PLACE-OF-SERVICE |
|
01/27/2023
|
3.2.0 |
Rule-7813
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL, then CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE |
|
01/27/2023
|
3.2.0 |
Rule-7814
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: 1', 'A' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE, then CLAIM-HEADER-RECORD-OT has a non-null value for TYPE-OF-BILL |
|
01/27/2023
|
3.2.0 |
Rule-7815
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE or CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE |
|
01/27/2023
|
3.2.0 |
Rule-7816
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-RX has a non-null value for DAYS-SUPPLY |
|
01/27/2023
|
3.2.0 |
Rule-7817
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-RX has a non-null value for PRESCRIPTION-QUANTITY-ACTUAL |
|
01/27/2023
|
3.2.0 |
Rule-7818
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NPI-NUM' |
|
01/27/2023
|
3.2.0 |
Rule-7819
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NPI' |
|
01/27/2023
|
3.2.0 |
Rule-7820
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NPI-NUM' |
|
01/27/2023
|
3.2.0 |
Rule-7821
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal ‘F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A’ and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-IP has a non-null value for BILLING-PROV-NUM |
|
01/27/2023
|
3.2.0 |
Rule-7822
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A’ and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-LT has a non-null value for BILLING-PROV-NUM |
|
01/27/2023
|
3.2.0 |
Rule-7823
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A’ and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM |
|
01/27/2023
|
3.2.0 |
Rule-7824
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A’ and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NUM |
|
01/27/2023
|
3.2.0 |
Rule-7825
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' then CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NPI-NUM or CLAIM-LINE-RECORD-OT has a non-null value for SERVICING-PROV-NUM |
|
01/27/2023
|
3.2.0 |
Rule-7826
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1','A' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' then CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NPI-NUM or CLAIM-HEADER-RECORD-OT has a non-null value for BILLING-PROV-NUM |
|
01/27/2023
|
3.2.0 |
Rule-7827
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', then CLAIM-HEADER-RECORD-RX has a non-null value for BILLING-PROV-NPI-NUM |
|
01/27/2023
|
3.2.0 |
Rule-7828
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-IP has a non-null value for SERVICING-PROV-NPI-NUM |
|
01/27/2023
|
3.2.0 |
Rule-7829
|
ADD |
Data Dictionary - Validation Rules |
N/A |
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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-LT has a non-null value for SERVICING-PROV-NPI-NUM |
|
01/27/2023
|
3.2.0 |
RULE-2432
|
UPDATE |
Data Dictionary - Validation Rules |
if RACE-INFORMATION.RACE is equal to one of the following: '010', '015', then RACE-INFORMATION has a valid, non-null value for RACE-OTHER |
if RACE-INFORMATION.RACE is equal to one of the following: '010', '015', '018’, then RACE-INFORMATION has a valid, non-null value for RACE-OTHER |
|
01/27/2023
|
3.2.0 |
RULE-7537
|
UPDATE |
Data Dictionary - Validation Rules |
if RACE-INFORMATION.RACE is not equal to one of the following: '010', '015', then RACE-INFORMATION has a null value for RACE-OTHER |
if RACE-INFORMATION.RACE is not equal to one of the following: ‘010', '015', '018’, then RACE-INFORMATION has a null value for RACE-OTHER |
|
06/08/2018
|
2.3.0 |
RULE-1630
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does not equal '585' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE |
'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE |
|
06/08/2018
|
2.3.0 |
RULE-1624
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does not equal '585' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE |
if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE |
|
05/11/2018
|
2.2.0 |
RULE-7167
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then when CLAIM-HEADER-RECORD-IP.DIAGNOSIS-RELATED-GROUP-IND is a CMS DRG Grouper, as specified by prefix 'HG', CLAIM-HEADER-RECORD-IP.DIAGNOSIS-RELATED-GROUP must be a valid value. We support valid values in 'MS-DRG-VERSION-11', 'MS-DRG-VERSION-12', 'MS-DRG-VERSION-13', 'MS-DRG-VERSION-14', 'MS-DRG-VERSION-15', 'MS-DRG-VERSION-16', 'MS-DRG-VERSION-17', 'MS-DRG-VERSION-18', 'MS-DRG-VERSION-19', 'MS-DRG-VERSION-20', 'MS-DRG-VERSION-21', 'MS-DRG-VERSION-22', 'MS-DRG-VERSION-23', 'MS-DRG-VERSION-24', 'MS-DRG-VERSION-25', 'MS-DRG-VERSION-26', 'MS-DRG-VERSION-27', 'MS-DRG-VERSION-28', 'MS-DRG-VERSION-29', 'MS-DRG-VERSION-30', 'MS-DRG-VERSION-31', 'MS-DRG-VERSION-32', or 'MS-DRG-VERSION-33'. |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then when CLAIM-HEADER-RECORD-IP.DIAGNOSIS-RELATED-GROUP-IND is a CMS DRG Grouper, as specified by prefix 'HG', CLAIM-HEADER-RECORD-IP.DIAGNOSIS-RELATED-GROUP must be a valid value. We support valid values in 'MS-DRG-VERSION-3', 'MS-DRG-VERSION-4', 'MS-DRG-VERSION-5', 'MS-DRG-VERSION-6', 'MS-DRG-VERSION-7', 'MS-DRG-VERSION-8', 'MS-DRG-VERSION-9', 'MS-DRG-VERSION-10', 'MS-DRG-VERSION-11', 'MS-DRG-VERSION-12', 'MS-DRG-VERSION-13', 'MS-DRG-VERSION-14', 'MS-DRG-VERSION-15', 'MS-DRG-VERSION-16', 'MS-DRG-VERSION-17', 'MS-DRG-VERSION-18', 'MS-DRG-VERSION-19', 'MS-DRG-VERSION-20', 'MS-DRG-VERSION-21', 'MS-DRG-VERSION-22', 'MS-DRG-VERSION-23', 'MS-DRG-VERSION-24', or 'MS-DRG-VERSION-25' |
|
04/13/2018
|
2.2.0 |
RULE-2165
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ELIGIBILITY-DETERMINANT-EFF-DATE. End date field: ELIGIBILITY-DETERMINANT-END-DATE |
N/A |
|
08/30/2018
|
2.3.0 |
RULE-982
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is greater than zero or CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is less than or equal to CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is greater than zero or CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is less than CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT |
|
06/22/2018
|
2.3.0 |
RULE-982
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is greater than zero or CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is less than CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT and (CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is greater than zero or CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT is greater than zero), then CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT is less than or equal to CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT |
|
01/31/2020
|
2.4.0 |
RULE-325
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-336
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CROSSOVER-INDICATOR'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CROSSOVER-INDICATOR' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-337
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-HOSPITAL'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-HOSPITAL' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-338
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-340
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND'' |
If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-341
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-342
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ADMISSION-TYPE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ADMISSION-TYPE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-346
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-349
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-350
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-355
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-356
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-361
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-362
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-367
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-368
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-373
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-374
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-379
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-384
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-389
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-394
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-399
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-404
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-409
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-416
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-418
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-429
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-431
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-442
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-444
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-455
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-458
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-469
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-471
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-482
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-484
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-496
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HOUR'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HOUR' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-503
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HOUR'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HOUR' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-510
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-CLAIM'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-CLAIM' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-511
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-IP.TYPE-OF-BILL is a valid type of bill code' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-IP.TYPE-OF-BILL is a valid type of bill code and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-512
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-513
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS-CATEGORY'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS-CATEGORY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-514
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SOURCE-LOCATION'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SOURCE-LOCATION' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-518
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ALLOWED-CHARGE-SRC'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ALLOWED-CHARGE-SRC' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-520
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-522
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-525
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-528
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-549
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-INSURANCE-IND'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-INSURANCE-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-550
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-551
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SERVICE-TRACKING-TYPE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SERVICE-TRACKING-TYPE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-555
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FIXED-PAYMENT-IND'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FIXED-PAYMENT-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-556
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-557
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-SOURCE-NONFEDERAL-SHARE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-SOURCE-NONFEDERAL-SHARE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-558
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-COMB-DED-IND'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-COMB-DED-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-560
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-569
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PAYMENT-LEVEL-IND'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PAYMENT-LEVEL-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-570
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-REIM-TYPE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-REIM-TYPE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-578
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FORCED-CLAIM-IND'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FORCED-CLAIM-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-579
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-CARE-ACQUIRED-CONDITION-IND'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-CARE-ACQUIRED-CONDITION-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-580
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-581
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-582
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-583
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-584
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-585
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-586
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-587
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-588
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-589
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-679
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-PROV-IND'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-PROV-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-681
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-693
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)' |
|
01/31/2020
|
2.4.0 |
RULE-694
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-695
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-699
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-700
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-701
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-705
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-706
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-707
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-714
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OUTLIER-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OUTLIER-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-718
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PATIENT-STATUS'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PATIENT-STATUS' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-723
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SPLIT-CLAIM-IND'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SPLIT-CLAIM-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-724
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'BORDER-STATE-IND'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'BORDER-STATE-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-734
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-DENIED-INDICATOR'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-DENIED-INDICATOR' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-736
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-IND'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-IND' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-750
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-753
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-756
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-761
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-774
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'. |
If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'. and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-776
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-778
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-792
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-793
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-805
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BILLING-UNIT'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BILLING-UNIT' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-806
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-814
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-815
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-816
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-820
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-821
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-FACILITY-TYPE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-FACILITY-TYPE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-822
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-823
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-826
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-828
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-837
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-842
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE' and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-7127
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-7128
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-7129
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-7130
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-7131
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-7132
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-7133
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date)
OR
(CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date)) |
|
01/31/2020
|
2.4.0 |
RULE-874
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-885
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CROSSOVER-INDICATOR'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CROSSOVER-INDICATOR' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-886
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-888
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND'' |
If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-889
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-891
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-894
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-895
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-900
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-901
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-906
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-907
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-912
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-913
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-918
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-919
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-925
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HOUR'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HOUR' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-931
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HOUR'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HOUR' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-951
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-CLAIM'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-CLAIM' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-952
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-LT.TYPE-OF-BILL is a valid type of bill code' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-LT.TYPE-OF-BILL is a valid type of bill code' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-953
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-954
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS-CATEGORY'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS-CATEGORY' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-955
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SOURCE-LOCATION'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SOURCE-LOCATION' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-959
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-961
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-964
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-967
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-988
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-INSURANCE-IND'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-INSURANCE-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-989
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-990
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SERVICE-TRACKING-TYPE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SERVICE-TRACKING-TYPE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-994
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FIXED-PAYMENT-IND'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FIXED-PAYMENT-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-995
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-996
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-SOURCE-NONFEDERAL-SHARE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-SOURCE-NONFEDERAL-SHARE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-997
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-COMB-DED-IND'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-COMB-DED-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-999
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1008
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PAYMENT-LEVEL-IND'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PAYMENT-LEVEL-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1009
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-REIM-TYPE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-REIM-TYPE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1017
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FORCED-CLAIM-IND'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FORCED-CLAIM-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1018
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-CARE-ACQUIRED-CONDITION-IND'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-CARE-ACQUIRED-CONDITION-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1019
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1020
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1021
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1022
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1023
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1024
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1025
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1026
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1027
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1028
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1117
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-PROV-IND'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-PROV-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1119
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1130
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
01/31/2020
|
2.4.0 |
RULE-1131
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1132
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1136
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1137
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1138
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1141
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PATIENT-STATUS'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PATIENT-STATUS' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1156
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SPLIT-CLAIM-IND'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SPLIT-CLAIM-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1157
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'BORDER-STATE-IND'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'BORDER-STATE-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1167
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-DENIED-INDICATOR'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-DENIED-INDICATOR' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1169
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-IND'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-IND' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1183
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1186
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1191
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1192
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1193
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1197
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1211
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'. |
If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'. and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1213
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1215
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1228
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1229
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1242
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BILLING-UNIT'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BILLING-UNIT' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1243
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1250
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1251
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1252
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1253
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1254
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1255
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1258
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-FACILITY-TYPE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-FACILITY-TYPE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1259
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1261
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1267
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1274
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE'' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE' and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1327
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1338
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CROSSOVER-INDICATOR'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CROSSOVER-INDICATOR' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1339
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1341
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND'' |
If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1342
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1345
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1346
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1350
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-CODE-FLAG' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1351
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'DIAGNOSIS-POA-FLAG' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1370
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-CLAIM'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-CLAIM' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1371
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-OT.TYPE-OF-BILL is a valid type of bill code' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-OT.TYPE-OF-BILL is a valid type of bill code' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1372
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1373
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS-CATEGORY'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS-CATEGORY' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1374
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SOURCE-LOCATION'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SOURCE-LOCATION' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1378
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1380
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1383
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1386
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1407
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-INSURANCE-IND'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-INSURANCE-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1408
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1409
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SERVICE-TRACKING-TYPE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SERVICE-TRACKING-TYPE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1413
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FIXED-PAYMENT-IND'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FIXED-PAYMENT-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1414
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-CODE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1415
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-SOURCE-NONFEDERAL-SHARE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-SOURCE-NONFEDERAL-SHARE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1416
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-COMB-DED-IND'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1418
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1427
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PAYMENT-LEVEL-IND'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PAYMENT-LEVEL-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1428
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-REIM-TYPE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-REIM-TYPE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1431
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FORCED-CLAIM-IND'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FORCED-CLAIM-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1432
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-CARE-ACQUIRED-CONDITION-IND'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-CARE-ACQUIRED-CONDITION-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1433
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1434
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1435
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1436
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1437
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1438
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1439
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1440
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1441
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1442
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1531
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-PROV-IND'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-PROV-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1533
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1545
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
|
01/31/2020
|
2.4.0 |
RULE-1547
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1548
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1553
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1555
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1556
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1559
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PLACE-OF-SERVICE'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PLACE-OF-SERVICE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1565
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'BORDER-STATE-IND'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'BORDER-STATE-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1575
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-DENIED-INDICATOR'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-DENIED-INDICATOR' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1577
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-IND'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-IND' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1595
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1599
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1603
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1616
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'. |
If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1618
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-REASON-CODE' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1620
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1633
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REVENUE-CODE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1641
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-FLAG' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1642
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1644
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1655
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1660
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-TAXONOMY'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-TAXONOMY' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1669
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1671
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1672
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1673
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1674
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-DESIGNATION-SYSTEM'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-DESIGNATION-SYSTEM' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1675
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-NUM'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-NUM' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1676
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-QUAD-CODE'' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-QUAD-CODE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1677
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-SURFACE-CODE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TOOTH-SURFACE-CODE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1681
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1687
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1689
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1690
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1693
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1695
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1703
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1706
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1713
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1715
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NDC-UNIT-OF-MEASURE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1718
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-7134
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-SERVICE-CODE'' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-SERVICE-CODE' and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE has non null value and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1749
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1759
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CROSSOVER-INDICATOR'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CROSSOVER-INDICATOR' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1760
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1762
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND'' |
If the field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1769
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-CLAIM'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-CLAIM' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1770
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1771
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS-CATEGORY'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS-CATEGORY' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1772
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SOURCE-LOCATION'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SOURCE-LOCATION' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1776
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1778
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1781
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1784
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1805
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-INSURANCE-IND'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-INSURANCE-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1806
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1807
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SERVICE-TRACKING-TYPE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'SERVICE-TRACKING-TYPE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1811
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FIXED-PAYMENT-IND'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FIXED-PAYMENT-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1812
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-CODE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-CODE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1813
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-SOURCE-NONFEDERAL-SHARE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FUNDING-SOURCE-NONFEDERAL-SHARE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1814
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROGRAM-TYPE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1823
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PAYMENT-LEVEL-IND'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PAYMENT-LEVEL-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1824
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-REIM-TYPE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-REIM-TYPE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1827
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FORCED-CLAIM-IND'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'FORCED-CLAIM-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1836
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-PROV-IND'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-PROV-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1838
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1849
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
|
01/31/2020
|
2.4.0 |
RULE-1850
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1854
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1855
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TYPE' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1856
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1860
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'BORDER-STATE-IND'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'BORDER-STATE-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1872
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COMPOUND-DRUG-IND'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COMPOUND-DRUG-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1881
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-DENIED-INDICATOR'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-DENIED-INDICATOR' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1883
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-IND'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1894
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'PROV-TAXONOMY' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1902
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1916
|
UPDATE |
Data Dictionary - Validation Rules |
If the LINE-ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'. |
If the LINE-ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1920
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CLAIM-STATUS' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1936
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'UNIT-OF-MEASURE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'UNIT-OF-MEASURE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1937
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-SERVICE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1940
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-SERVICE-CODE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-SERVICE-CODE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1941
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-TAXONOMY'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-TAXONOMY' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1942
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'OTHER-TPL-COLLECTION' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1944
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NEW-REFILL-IND'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'NEW-REFILL-IND' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1945
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BRAND-GENERIC-IND'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BRAND-GENERIC-IND' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1950
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'COMPOUND-DOSAGE-FORM'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'COMPOUND-DOSAGE-FORM' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1951
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REBATE-ELIGIBLE-INDICATOR'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'REBATE-ELIGIBLE-INDICATOR' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1952
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'IMMUNIZATION-TYPE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1953
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'BENEFIT-TYPE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1954
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1957
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1959
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XXI-MBESCBES-CATEGORY-OF-SERVICE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1968
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE' and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-LINE-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-1970
|
UPDATE |
Data Dictionary - Validation Rules |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-COMB-DED-IND'' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the field is populated, the value must be contained in the set of valid values with id: 'MEDICARE-COMB-DED-IND' and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE has non null value and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2003
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2012
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'SEX'' |
If the field is populated, the value must be contained in the set of valid values with id: 'SEX' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2036
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2043
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'SSN-VERIFICATION-FLAG'' |
If the field is populated, the value must be contained in the set of valid values with id: 'SSN-VERIFICATION-FLAG' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2044
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'INCOME-CODE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'INCOME-CODE' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2045
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'VETERAN-IND'' |
If the field is populated, the value must be contained in the set of valid values with id: 'VETERAN-IND' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2047
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'CITIZENSHIP-IND'' |
If the field is populated, the value must be contained in the set of valid values with id: 'CITIZENSHIP-IND' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2049
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'CITIZENSHIP-VERIFICATION-FLAG'' |
If the field is populated, the value must be contained in the set of valid values with id: 'CITIZENSHIP-VERIFICATION-FLAG' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2050
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'IMMIGRATION-STATUS'' |
If the field is populated, the value must be contained in the set of valid values with id: 'IMMIGRATION-STATUS' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2052
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'IMMIGRATION-VERIFICATION-FLAG'' |
If the field is populated, the value must be contained in the set of valid values with id: 'IMMIGRATION-VERIFICATION-FLAG' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2057
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'PRIMARY-LANGUAGE-ENGL-PROF-CODE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'PRIMARY-LANGUAGE-ENGL-PROF-CODE' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2059
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'PRIMARY-LANGUAGE-CODE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'PRIMARY-LANGUAGE-CODE' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2061
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'HOUSEHOLD-SIZE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'HOUSEHOLD-SIZE' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2062
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'PREGNANCY-IND'' |
If the field is populated, the value must be contained in the set of valid values with id: 'PREGNANCY-IND' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2067
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'CHIP-CODE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'CHIP-CODE' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHICS-ELEMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2080
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and ELIGIBLE-CONTACT-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2087
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'ELIGIBLE-ADDR-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'ELIGIBLE-ADDR-TYPE' and ELIGIBLE-CONTACT-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2096
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and ELIGIBLE-CONTACT-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2098
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'COUNTY'' |
If the field is populated, the value must be contained in the set of valid values with id: 'COUNTY' and ELIGIBLE-CONTACT-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-ADDR-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2114
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2122
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'MEDICAID-BASIS-OF-ELIGIBILITY'' |
If the field is populated, the value must be contained in the set of valid values with id: 'MEDICAID-BASIS-OF-ELIGIBILITY' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2126
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'DUAL-ELIGIBLE-CODE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'DUAL-ELIGIBLE-CODE' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2132
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'PRIMARY-ELIGIBILITY-GROUP-IND'' |
If the field is populated, the value must be contained in the set of valid values with id: 'PRIMARY-ELIGIBILITY-GROUP-IND' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2135
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'ELIGIBILITY-GROUP'' |
If the field is populated, the value must be contained in the set of valid values with id: 'ELIGIBILITY-GROUP' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2136
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'LEVEL-OF-CARE-STATUS'' |
If the field is populated, the value must be contained in the set of valid values with id: 'LEVEL-OF-CARE-STATUS' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2137
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'SSDI-IND'' |
If the field is populated, the value must be contained in the set of valid values with id: 'SSDI-IND' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2138
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'SSI-IND'' |
If the field is populated, the value must be contained in the set of valid values with id: 'SSI-STATE-SUPPLEMENT-STATUS-CODE' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2140
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'SSI-STATE-SUPPLEMENT-STATUS-CODE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'SSI-STATE-SUPPLEMENT-STATUS-CODE' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2142
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'SSI-STATUS'' |
If the field is populated, the value must be contained in the set of valid values with id: 'SSI-STATUS' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2144
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'STATE-SPEC-ELIG-GROUP'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE-SPEC-ELIG-GROUP' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2145
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'CONCEPTION-TO-BIRTH-IND'' |
If the field is populated, the value must be contained in the set of valid values with id: 'CONCEPTION-TO-BIRTH-IND' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2146
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'ELIGIBILITY-CHANGE-REASON'' |
If the field is populated, the value must be contained in the set of valid values with id: 'ELIGIBILITY-CHANGE-REASON' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2154
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'RESTRICTED-BENEFITS-CODE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'RESTRICTED-BENEFITS-CODE' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2159
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'TANF-CASH-CODE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'TANF-CASH-CODE' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2174
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and HEALTH-HOME-SPA-PARTICIPATION-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and HEALTH-HOME-SPA-PARTICIPATION-INFORMATION.HEALTH-HOME-SPA-PARTICIPATION-EFF-DATE must be >= Valid Values Effective-Date and HEALTH-HOME-SPA-PARTICIPATION-INFORMATION.HEALTH-HOME-SPA-PARTICIPATION-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2201
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and HEALTH-HOME-SPA-PROVIDERS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and HEALTH-HOME-SPA-PROVIDERS.HEALTH-HOME-SPA-PROVIDER-EFF-DATE must be >= Valid Values Effective-Date and HEALTH-HOME-SPA-PROVIDERS.HEALTH-HOME-SPA-PROVIDER-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2228
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and HEALTH-HOME-CHRONIC-CONDITIONS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and HEALTH-HOME-CHRONIC-CONDITIONS.HEALTH-HOME-CHRONIC-CONDITION-EFF-DATE must be >= Valid Values Effective-Date and HEALTH-HOME-CHRONIC-CONDITIONS.HEALTH-HOME-CHRONIC-CONDITION-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2235
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-CHRONIC-CONDITION'' |
If the field is populated, the value must be contained in the set of valid values with id: 'HEALTH-HOME-CHRONIC-CONDITION' and HEALTH-HOME-CHRONIC-CONDITIONS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and HEALTH-HOME-CHRONIC-CONDITIONS.HEALTH-HOME-CHRONIC-CONDITION-EFF-DATE must be >= Valid Values Effective-Date and HEALTH-HOME-CHRONIC-CONDITIONS.HEALTH-HOME-CHRONIC-CONDITION-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2250
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and LOCK-IN-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and LOCK-IN-INFORMATION.LOCKIN-EFF-DATE must be >= Valid Values Effective-Date and LOCK-IN-INFORMATION.LOCKIN-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2273
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MFP-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2280
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'MFP-LIVES-WITH-FAMILY'' |
If the field is populated, the value must be contained in the set of valid values with id: 'MFP-LIVES-WITH-FAMILY' and MFP-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2281
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'MFP-QUALIFIED-INSTITUTION'' |
If the field is populated, the value must be contained in the set of valid values with id: 'MFP-QUALIFIED-INSTITUTION' and MFP-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2282
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'MFP-QUALIFIED-RESIDENCE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'MFP-QUALIFIED-RESIDENCE' and MFP-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2283
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'MFP-REASON-PARTICIPATION-ENDED'' |
If the field is populated, the value must be contained in the set of valid values with id: 'MFP-REASON-PARTICIPATION-ENDED' and MFP-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2285
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'MFP-REINSTITUTIONALIZED-REASON'' |
If the field is populated, the value must be contained in the set of valid values with id: 'MFP-REINSTITUTIONALIZED-REASON' and MFP-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MFP-INFORMATION.MFP-ENROLLMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2300
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and STATE-PLAN-OPTION-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-EFF-DATE must be >= Valid Values Effective-Date and STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2307
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE-PLAN-OPTION-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE-PLAN-OPTION-TYPE' and STATE-PLAN-OPTION-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-EFF-DATE must be >= Valid Values Effective-Date and STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2323
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and WAIVER-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2334
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'WAIVER-TYPE' and WAIVER-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2348
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and LTSS-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and LTSS-PARTICIPATION.LTSS-ELIGIBILITY-EFF-DATE must be >= Valid Values Effective-Date and LTSS-PARTICIPATION.LTSS-ELIGIBILITY-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2355
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'LTSS-LEVEL-CARE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'LTSS-LEVEL-CARE' and LTSS-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and LTSS-PARTICIPATION.LTSS-ELIGIBILITY-EFF-DATE must be >= Valid Values Effective-Date and LTSS-PARTICIPATION.LTSS-ELIGIBILITY-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2371
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MANAGED-CARE-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2385
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-PLAN-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-PLAN-TYPE' and MANAGED-CARE-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2388
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE' and MANAGED-CARE-PARTICIPATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2402
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and ETHNICITY-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ETHNICITY-INFORMATION.ETHNICITY-DECLARATION-EFF-DATE must be >= Valid Values Effective-Date and ETHNICITY-INFORMATION.ETHNICITY-DECLARATION-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2409
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'ETHNICITY-CODE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'ETHNICITY-CODE' and ETHNICITY-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ETHNICITY-INFORMATION.ETHNICITY-DECLARATION-EFF-DATE must be >= Valid Values Effective-Date and ETHNICITY-INFORMATION.ETHNICITY-DECLARATION-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2424
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and RACE-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and RACE-INFORMATION.RACE-DECLARATION-EFF-DATE must be >= Valid Values Effective-Date and RACE-INFORMATION.RACE-DECLARATION-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2431
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'RACE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'RACE' and RACE-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and RACE-INFORMATION.RACE-DECLARATION-EFF-DATE must be >= Valid Values Effective-Date and RACE-INFORMATION.RACE-DECLARATION-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2434
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR'' |
If the field is populated, the value must be contained in the set of valid values with id: 'CERTIFIED-AMERICAN-INDIAN-ALASKAN-NATIVE-INDICATOR' and RACE-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and RACE-INFORMATION.RACE-DECLARATION-EFF-DATE must be >= Valid Values Effective-Date and RACE-INFORMATION.RACE-DECLARATION-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2447
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and DISABILITY-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and DISABILITY-INFORMATION.DISABILITY-TYPE-EFF-DATE must be >= Valid Values Effective-Date and DISABILITY-INFORMATION.DISABILITY-TYPE-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2454
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'DISABILITY-TYPE-CODE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'DISABILITY-TYPE-CODE' and DISABILITY-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and DISABILITY-INFORMATION.DISABILITY-TYPE-EFF-DATE must be >= Valid Values Effective-Date and DISABILITY-INFORMATION.DISABILITY-TYPE-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2467
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and 1115A-DEMONSTRATION-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and 1115A-DEMONSTRATION-INFORMATION.1115A-EFF-DATE must be >= Valid Values Effective-Date and 1115A-DEMONSTRATION-INFORMATION.1115A-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2474
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND'' |
If the field is populated, the value must be contained in the set of valid values with id: '1115A-DEMONSTRATION-IND' and 1115A-DEMONSTRATION-INFORMATION.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and 1115A-DEMONSTRATION-INFORMATION.1115A-EFF-DATE must be >= Valid Values Effective-Date and 1115A-DEMONSTRATION-INFORMATION.1115A-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2488
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME.HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-EFF-DATE must be >= Valid Values Effective-Date and HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME.HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2495
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-CODE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-CODE' and HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME.HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-EFF-DATE must be >= Valid Values Effective-Date and HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME.HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2507
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and ENROLLMENT-TIME-SPAN-SEGMENT.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2514
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'ENROLLMENT-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'ENROLLMENT-TYPE' and ENROLLMENT-TIME-SPAN-SEGMENT.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE must be >= Valid Values Effective-Date and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-7142
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'MARITAL-STATUS'' |
If the field is populated, the value must be contained in the set of valid values with id: 'MARITAL-STATUS' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE must be >= Valid Values Effective-Date and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-7153
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'MAINTENANCE-ASSISTANCE-STATUS'' |
If the field is populated, the value must be contained in the set of valid values with id: 'MAINTENANCE-ASSISTANCE-STATUS' and ELIGIBILITY-DETERMINANTS.PRIMARY-DEMOGRAPHIC-ELEMENT-EFFECTIVE-DATE has non null value and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE must be >= Valid Values Effective-Date and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2553
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE has non null value and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2567
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-PROGRAM'' |
If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-PROGRAM' and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE has non null value and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2568
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-PLAN-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-PLAN-TYPE' and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE has non null value and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2569
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'REIMBURSEMENT-ARRANGEMENT'' |
If the field is populated, the value must be contained in the set of valid values with id: 'REIMBURSEMENT-ARRANGEMENT' and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE has non null value and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2570
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-PROFIT-STATUS'' |
If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-PROFIT-STATUS' and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE has non null value and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2571
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'CORE-BASED-STATISTICAL-AREA-CODE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'CORE-BASED-STATISTICAL-AREA-CODE' and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE has non null value and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2574
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-SERVICE-AREA'' |
If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-SERVICE-AREA' and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE has non null value and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-MAIN.MANAGED-CARE-MAIN-REC-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2586
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2604
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-ADDR-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-ADDR-TYPE' and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2614
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2616
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'COUNTY'' |
If the field is populated, the value must be contained in the set of valid values with id: 'COUNTY' and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2623
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE has non null value and MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-SERVICE-AREA.MANAGED-CARE-SERVICE-AREA-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2645
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MANAGED-CARE-OPERATING-AUTHORITY.MANAGED-CARE-OP-AUTHORITY-EFF-DATE has non null value and MANAGED-CARE-OPERATING-AUTHORITY.MANAGED-CARE-OP-AUTHORITY-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-OPERATING-AUTHORITY.MANAGED-CARE-OP-AUTHORITY-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2653
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'OPERATING-AUTHORITY'' |
If the field is populated, the value must be contained in the set of valid values with id: 'OPERATING-AUTHORITY' and MANAGED-CARE-OPERATING-AUTHORITY.MANAGED-CARE-OP-AUTHORITY-EFF-DATE has non null value and MANAGED-CARE-OPERATING-AUTHORITY.MANAGED-CARE-OP-AUTHORITY-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-OPERATING-AUTHORITY.MANAGED-CARE-OP-AUTHORITY-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2668
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MANAGED-CARE-PLAN-POPULATION-ENROLLED.MANAGED-CARE-PLAN-POP-EFF-DATE has non null value and MANAGED-CARE-PLAN-POPULATION-ENROLLED.MANAGED-CARE-PLAN-POP-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-PLAN-POPULATION-ENROLLED.MANAGED-CARE-PLAN-POP-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2676
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'ELIGIBILITY-GROUP'' |
If the field is populated, the value must be contained in the set of valid values with id: 'ELIGIBILITY-GROUP' and MANAGED-CARE-PLAN-POPULATION-ENROLLED.MANAGED-CARE-PLAN-POP-EFF-DATE has non null value and MANAGED-CARE-PLAN-POPULATION-ENROLLED.MANAGED-CARE-PLAN-POP-EFF-DATE must be >= Valid Values Effective-Date and MANAGED-CARE-PLAN-POPULATION-ENROLLED.MANAGED-CARE-PLAN-POP-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2689
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and MANAGED-CARE-ACCREDITATION-ORGANIZATION.DATE-ACCREDITATION-ACHIEVED has non null value and MANAGED-CARE-ACCREDITATION-ORGANIZATION.DATE-ACCREDITATION-ACHIEVED must be >= Valid Values Effective-Date and MANAGED-CARE-ACCREDITATION-ORGANIZATION.DATE-ACCREDITATION-ACHIEVED <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2697
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'ACCREDITATION-ORGANIZATION'' |
If the field is populated, the value must be contained in the set of valid values with id: 'ACCREDITATION-ORGANIZATION' and MANAGED-CARE-ACCREDITATION-ORGANIZATION.DATE-ACCREDITATION-ACHIEVED has non null value and MANAGED-CARE-ACCREDITATION-ORGANIZATION.DATE-ACCREDITATION-ACHIEVED must be >= Valid Values Effective-Date and MANAGED-CARE-ACCREDITATION-ORGANIZATION.DATE-ACCREDITATION-ACHIEVED <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2710
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE has non null value and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE must be >= Valid Values Effective-Date and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2720
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE' and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE has non null value and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE must be >= Valid Values Effective-Date and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2736
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and CHPID-SHPID-RELATIONSHIPS.CHPID-SHPID-RELATIONSHIP-EFF-DATE has non null value and CHPID-SHPID-RELATIONSHIPS.CHPID-SHPID-RELATIONSHIP-EFF-DATE must be >= Valid Values Effective-Date and CHPID-SHPID-RELATIONSHIPS.CHPID-SHPID-RELATIONSHIP-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2785
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE has non null value and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE must be >= Valid Values Effective-Date and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2803
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'FACILITY-GROUP-INDIVIDUAL-CODE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'FACILITY-GROUP-INDIVIDUAL-CODE' and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE has non null value and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE must be >= Valid Values Effective-Date and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2804
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'TEACHING-IND'' |
If the field is populated, the value must be contained in the set of valid values with id: 'TEACHING-IND' and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE has non null value and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE must be >= Valid Values Effective-Date and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2812
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'SEX'' |
If the field is populated, the value must be contained in the set of valid values with id: 'SEX' and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE has non null value and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE must be >= Valid Values Effective-Date and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2815
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'OWNERSHIP-CODE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'OWNERSHIP-CODE' and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE has non null value and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE must be >= Valid Values Effective-Date and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2816
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'PROV-PROFIT-STATUS'' |
If the field is populated, the value must be contained in the set of valid values with id: 'PROV-PROFIT-STATUS' and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE has non null value and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE must be >= Valid Values Effective-Date and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2825
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'ACCEPTING-NEW-PATIENTS-IND'' |
If the field is populated, the value must be contained in the set of valid values with id: 'ACCEPTING-NEW-PATIENTS-IND' and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE has non null value and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE must be >= Valid Values Effective-Date and PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2829
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2848
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'PROV-ADDR-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'PROV-ADDR-TYPE' and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2856
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2861
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'ADDR-BORDER-STATE-IND'' |
If the field is populated, the value must be contained in the set of valid values with id: 'ADDR-BORDER-STATE-IND' and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2863
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'COUNTY'' |
If the field is populated, the value must be contained in the set of valid values with id: 'COUNTY' and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE has non null value and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and PROV-LOCATION-AND-CONTACT-INFO.PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2868
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-LICENSING-INFO.PROV-LICENSE-EFF-DATE has non null value and PROV-LICENSING-INFO.PROV-LICENSE-EFF-DATE must be >= Valid Values Effective-Date and PROV-LICENSING-INFO.PROV-LICENSE-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2884
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'LICENSE-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'LICENSE-TYPE' and PROV-LICENSING-INFO.PROV-LICENSE-EFF-DATE has non null value and PROV-LICENSING-INFO.PROV-LICENSE-EFF-DATE must be >= Valid Values Effective-Date and PROV-LICENSING-INFO.PROV-LICENSE-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2893
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE has non null value and PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE must be >= Valid Values Effective-Date and PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2900
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'PROV-IDENTIFIER-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'PROV-IDENTIFIER-TYPE' and PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE has non null value and PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE must be >= Valid Values Effective-Date and PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2921
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE has non null value and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE must be >= Valid Values Effective-Date and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2927
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'PROV-CLASSIFICATION-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'PROV-CLASSIFICATION-TYPE' and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE has non null value and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE must be >= Valid Values Effective-Date and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2928
|
UPDATE |
Data Dictionary - Validation Rules |
if PROV-TAXONOMY-CLASSIFICATION has a valid, non-null value for PROV-CLASSIFICATION-TYPE and PROV-TAXONOMY-CLASSIFICATION has a valid, non-null value for PROV-CLASSIFICATION-CODE, then if PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-TYPE is '1' then PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-CODE is a valid value in 'PROV-CLASSIFICATION-CODE-TYPE-1' on the date specified by PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE. If PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-TYPE is '2' then PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-CODE is a valid value in 'PROV-SPECIALTY' on the date specified by PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE. If PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-TYPE is '3' then PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-CODE is a valid value in 'PROV-TYPE' on the date specified by PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE. If PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-TYPE is '4' then PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-CODE is a valid value in 'PROV-CLASSIFICATION-CODE-TYPE-4' on the date specified by PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE.' |
if PROV-TAXONOMY-CLASSIFICATION has a valid, non-null value for PROV-CLASSIFICATION-TYPE and PROV-TAXONOMY-CLASSIFICATION has a valid, non-null value for PROV-CLASSIFICATION-CODE, then if PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-TYPE is '1' then PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-CODE is a valid value in 'PROV-CLASSIFICATION-CODE-TYPE-1' on the date specified by PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE. If PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-TYPE is '2' then PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-CODE is a valid value in 'PROV-SPECIALTY' on the date specified by PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE. If PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-TYPE is '3' then PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-CODE is a valid value in 'PROV-TYPE' on the date specified by PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE. If PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-TYPE is '4' then PROV-TAXONOMY-CLASSIFICATION.PROV-CLASSIFICATION-CODE is a valid value in 'PROV-CLASSIFICATION-CODE-TYPE-4' on the date specified by PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE.' and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE has non null value and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE must be >= Valid Values Effective-Date and PROV-TAXONOMY-CLASSIFICATION.PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2941
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE has non null value and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE must be >= Valid Values Effective-Date and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2956
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'PROV-MEDICAID-ENROLLMENT-STATUS-CODE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'PROV-MEDICAID-ENROLLMENT-STATUS-CODE' and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE has non null value and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE must be >= Valid Values Effective-Date and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2957
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'STATE-PLAN-ENROLLMENT'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE-PLAN-ENROLLMENT' and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE has non null value and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE must be >= Valid Values Effective-Date and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2958
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'PROV-ENROLLMENT-METHOD'' |
If the field is populated, the value must be contained in the set of valid values with id: 'PROV-ENROLLMENT-METHOD' and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE has non null value and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE must be >= Valid Values Effective-Date and PROV-MEDICAID-ENROLLMENT.PROV-MEDICAID-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2964
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-AFFILIATED-GROUPS.PROV-AFFILIATED-GROUP-EFF-DATE has non null value and PROV-AFFILIATED-GROUPS.PROV-AFFILIATED-GROUP-EFF-DATE must be >= Valid Values Effective-Date and PROV-AFFILIATED-GROUPS.PROV-AFFILIATED-GROUP-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2983
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-EFF-DATE has non null value and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-EFF-DATE must be >= Valid Values Effective-Date and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-2989
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'AFFILIATED-PROGRAM-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'AFFILIATED-PROGRAM-TYPE' and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-EFF-DATE has non null value and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-EFF-DATE must be >= Valid Values Effective-Date and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3005
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and PROV-BED-TYPE-INFO.BED-TYPE-EFF-DATE has non null value and PROV-BED-TYPE-INFO.BED-TYPE-EFF-DATE must be >= Valid Values Effective-Date and PROV-BED-TYPE-INFO.BED-TYPE-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3022
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'BED-TYPE-CODE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'BED-TYPE-CODE' and PROV-BED-TYPE-INFO.BED-TYPE-EFF-DATE has non null value and PROV-BED-TYPE-INFO.BED-TYPE-EFF-DATE must be >= Valid Values Effective-Date and PROV-BED-TYPE-INFO.BED-TYPE-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3054
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3062
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'TPL-HEALTH-INSURANCE-COVERAGE-IND'' |
If the field is populated, the value must be contained in the set of valid values with id: 'TPL-HEALTH-INSURANCE-COVERAGE-IND' and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3063
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'TPL-OTHER-COVERAGE-IND'' |
If the field is populated, the value must be contained in the set of valid values with id: 'TPL-OTHER-COVERAGE-IND' and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.ELIG-PRSN-MAIN-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3078
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3091
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'INSURANCE-PLAN-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'INSURANCE-PLAN-TYPE' and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3099
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'POLICY-OWNER-CODE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'POLICY-OWNER-CODE' and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3115
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3122
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'INSURANCE-PLAN-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'INSURANCE-PLAN-TYPE' and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3123
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'COVERAGE-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'COVERAGE-TYPE' and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3136
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.OTHER-TPL-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.OTHER-TPL-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.OTHER-TPL-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3144
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-OTHER-THIRD-PARTY-LIABILITY'' |
If the field is populated, the value must be contained in the set of valid values with id: 'TYPE-OF-OTHER-THIRD-PARTY-LIABILITY' and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.OTHER-TPL-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.OTHER-TPL-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.OTHER-TPL-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3157
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE has non null value and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3162
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'TPL-ENTITY-ADDR-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'TPL-ENTITY-ADDR-TYPE' and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE has non null value and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3170
|
UPDATE |
Data Dictionary - Validation Rules |
'If the field is populated, the value must be contained in the set of valid values with id: 'STATE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'STATE' and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE has non null value and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3182
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'COVERAGE-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'COVERAGE-TYPE' and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE has non null value and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE must be >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE <= Valid Values End-Date |
|
01/31/2020
|
2.4.0 |
RULE-3185
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE'' |
If the field is populated, the value must be contained in the set of valid values with id: 'NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE' and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE has non null value and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE must be >= Valid Values Effective-Date and TPL-ENTITY-CONTACT-INFORMATION.TPL-ENTITY-CONTACT-INFO-EFF-DATE <= Valid Values End-Date |
|
04/13/2018
|
2.2.0 |
RULE-572
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for NON-COV-DAYS and CLAIM-HEADER-RECORD-IP has a valid, non-null value for MEDICAID-COV-INPATIENT-DAYS, then the sum of CLAIM-HEADER-RECORD-IP.NON-COV-DAYS and CLAIM-HEADER-RECORD-IP.MEDICAID-COV-INPATIENT-DAYS is less than or equal to the number of days between the earliest CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE date and the latest CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE date', where CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS does not equal '585' |
N/A |
|
04/13/2018
|
2.2.0 |
RULE-1011
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for NON-COV-DAYS and CLAIM-HEADER-RECORD-LT has a valid, non-null value for MEDICAID-COV-INPATIENT-DAYS and CLAIM-HEADER-RECORD-LT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT has a valid, non-null value for ENDING-DATE-OF-SERVICE, then the sum of CLAIM-HEADER-RECORD-LT.NON-COV-DAYS and CLAIM-HEADER-RECORD-LT.MEDICAID-COV-INPATIENT-DAYS is less than or equal to the number of days between CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE |
N/A |
|
12/29/2017
|
2.2.0 |
RULE-561
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.PROGRAM-TYPE equals '07', then CLAIM-HEADER-RECORD-IP.WAIVER-TYPE is equal to one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20' |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.PROGRAM-TYPE equals '07', then CLAIM-HEADER-RECORD-IP.WAIVER-TYPE is equal to one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20', '33' |
|
12/29/2017
|
2.2.0 |
RULE-1419
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.PROGRAM-TYPE equals '07', then CLAIM-HEADER-RECORD-OT.WAIVER-TYPE is equal to one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20' |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.PROGRAM-TYPE equals '07', then CLAIM-HEADER-RECORD-OT.WAIVER-TYPE is equal to one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20', '33' |
|
12/29/2017
|
2.2.0 |
RULE-1000
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.PROGRAM-TYPE equals '07', then CLAIM-HEADER-RECORD-LT.WAIVER-TYPE is equal to one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20' |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.PROGRAM-TYPE equals '07', then CLAIM-HEADER-RECORD-LT.WAIVER-TYPE is equal to one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20', '33' |
|
03/30/2018
|
2.2.0 |
RULE-482
|
UPDATE |
Data Dictionary - Validation Rules |
Value not valid for state-supplied format (format or valid values) |
Value not in specified valid value set |
|
03/30/2018
|
2.2.0 |
RULE-469
|
UPDATE |
Data Dictionary - Validation Rules |
Value not valid for state-supplied format (format or valid values) |
Value not in specified valid value set |
|
03/30/2018
|
2.2.0 |
RULE-455
|
UPDATE |
Data Dictionary - Validation Rules |
Value not valid for state-supplied format (format or valid values) |
Value not in specified valid value set |
|
03/30/2018
|
2.2.0 |
RULE-442
|
UPDATE |
Data Dictionary - Validation Rules |
Value not valid for state-supplied format (format or valid values) |
Value not in specified valid value set |
|
03/30/2018
|
2.2.0 |
RULE-429
|
UPDATE |
Data Dictionary - Validation Rules |
Value not valid for state-supplied format (format or valid values) |
Value not in specified valid value set |
|
03/30/2018
|
2.2.0 |
RULE-416
|
UPDATE |
Data Dictionary - Validation Rules |
Value not valid for state-supplied format (format or valid values) |
Value not in specified valid value set |
|
03/30/2018
|
2.2.0 |
RULE-1718
|
UPDATE |
Data Dictionary - Validation Rules |
Value not valid for state-supplied format (format or valid values) |
Value not in specified valid value set |
|
03/30/2018
|
2.2.0 |
RULE-1706
|
UPDATE |
Data Dictionary - Validation Rules |
Value not valid for state-supplied format (format or valid values) |
Value not in specified valid value set |
|
03/30/2018
|
2.2.0 |
RULE-1703
|
UPDATE |
Data Dictionary - Validation Rules |
Value not valid for state-supplied format (format or valid values) |
Value not in specified valid value set |
|
03/30/2018
|
2.2.0 |
RULE-1642
|
UPDATE |
Data Dictionary - Validation Rules |
Value not valid for state-supplied format (format or valid values) |
Value not in specified valid value set |
|
02/23/2018
|
2.2.0 |
RULE-2863
|
UPDATE |
Data Dictionary - Validation Rules |
if PROV-LOCATION-AND-CONTACT-INFO has a valid, non-null value for ADDR-COUNTY, then PROV-LOCATION-AND-CONTACT-INFO has a valid, non-null value for SUBMITTING-STATE and The concatenation of PROV-LOCATION-AND-CONTACT-INFO.SUBMITTING-STATE and PROV-LOCATION-AND-CONTACT-INFO.ADDR-COUNTY must be contained in the set of valid values with id: 'COUNTY' |
if PROV-LOCATION-AND-CONTACT-INFO has a valid, non-null value for ADDR-COUNTY, then PROV-LOCATION-AND-CONTACT-INFO has a valid, non-null value for ADDR-STATE and The concatenation of PROV-LOCATION-AND-CONTACT-INFO. ADDR-STATE and PROV-LOCATION-AND-CONTACT-INFO.ADDR-COUNTY must be contained in the set of valid values with id: 'COUNTY' |
|
02/23/2018
|
2.2.0 |
RULE-2616
|
UPDATE |
Data Dictionary - Validation Rules |
if MANAGED-CARE-LOCATION-AND-CONTACT-INFO has a valid, non-null value for MANAGED-CARE-COUNTY, then MANAGED-CARE-LOCATION-AND-CONTACT-INFO has a valid, non-null value for SUBMITTING-STATE and The concatenation of MANAGED-CARE-LOCATION-AND-CONTACT-INFO.SUBMITTING-STATE and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-COUNTY must be contained in the set of valid values with id: 'COUNTY' |
if MANAGED-CARE-LOCATION-AND-CONTACT-INFO has a valid, non-null value for MANAGED-CARE-COUNTY, then MANAGED-CARE-LOCATION-AND-CONTACT-INFO has a valid, non-null value for MANAGED-CARE-STATE and The concatenation of MANAGED-CARE-LOCATION-AND-CONTACT-INFO. MANAGED-CARE-STATE and MANAGED-CARE-LOCATION-AND-CONTACT-INFO.MANAGED-CARE-COUNTY must be contained in the set of valid values with id: 'COUNTY' |
|
02/23/2018
|
2.2.0 |
RULE-2098
|
UPDATE |
Data Dictionary - Validation Rules |
if ELIGIBLE-CONTACT-INFORMATION has a valid, non-null value for ELIGIBLE-COUNTY-CODE, then ELIGIBLE-CONTACT-INFORMATION has a valid, non-null value for SUBMITTING-STATE and The concatenation of ELIGIBLE-CONTACT-INFORMATION.SUBMITTING-STATE and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-COUNTY-CODE must be contained in the set of valid values with id: 'COUNTY'' |
if ELIGIBLE-CONTACT-INFORMATION has a valid, non-null value for ELIGIBLE-COUNTY-CODE, then ELIGIBLE-CONTACT-INFORMATION has a valid, non-null value for ELIGIBLE-STATE and The concatenation of ELIGIBLE-CONTACT-INFORMATION. ELIGIBLE-STATE and ELIGIBLE-CONTACT-INFORMATION.ELIGIBLE-COUNTY-CODE must be contained in the set of valid values with id: 'COUNTY' |
|
05/25/2018
|
2.2.0 |
RULE-6604
|
UPDATE |
Data Dictionary - Validation Rules |
"Value must be compatible with specified T-MSIS picture format: 9(9)" |
"Value must be compatible with specified T-MSIS picture format: X(9)" |
|
05/25/2018
|
2.2.0 |
RULE-7182
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if the SSN is populated, the value submitted for.SSN must be a 9-digit number |
|
08/30/2018
|
2.3.0 |
RULE-884
|
UPDATE |
Data Dictionary - Validation Rules |
If (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data element should be NOT NULL
SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM,
CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and
ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
Date check on CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE |
|
08/30/2018
|
2.3.0 |
RULE-335
|
UPDATE |
Data Dictionary - Validation Rules |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data element should be NOT NULL
SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-IP.ADMISSION-DATE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
N/A |
|
08/30/2018
|
2.3.0 |
RULE-1758
|
UPDATE |
Data Dictionary - Validation Rules |
If (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) OR CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data element should be NOT NULL
SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM,
CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and
ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
Date check on Date check on CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE |
|
08/30/2018
|
2.3.0 |
RULE-1337
|
UPDATE |
Data Dictionary - Validation Rules |
If (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654"))
then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data element should be NOT NULL
SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM,
CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and
ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
Date check on CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.END-DATE-OF-SERVICE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE |
|
07/06/2018
|
2.3.0 |
RULE-884
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
Date check on CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE |
If (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data element should be NOT NULL
SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM,
CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and
ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
|
07/06/2018
|
2.3.0 |
RULE-335
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
Date check on CLAIM-HEADER-RECORD-IP.ADMISSION-DATE and CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE |
If (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data element should be NOT NULL
SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-IP.ADMISSION-DATE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
|
07/06/2018
|
2.3.0 |
RULE-1758
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
Date check on Date check on CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE |
If (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) OR CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data element should be NOT NULL
SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM,
CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and
ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
|
07/06/2018
|
2.3.0 |
RULE-1337
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
Date check on CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.END-DATE-OF-SERVICE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE |
If (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data element should be NOT NULL
SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM,
CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and
ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
|
08/30/2018
|
2.3.0 |
RULE-3060
|
UPDATE |
Data Dictionary - Validation Rules |
record TPL-MEDICAID-ELIGIBLE-PERSON-MAIN has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
N/A |
|
07/06/2018
|
2.3.0 |
RULE-3060
|
ADD |
Data Dictionary - Validation Rules |
N/A |
record TPL-MEDICAID-ELIGIBLE-PERSON-MAIN has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
|
08/30/2018
|
2.3.0 |
RULE-2165
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ELIGIBILITY-DETERMINANT-EFF-DATE. End date field: ELIGIBILITY-DETERMINANT-END-DATE |
N/A |
|
07/06/2018
|
2.3.0 |
RULE-2165
|
ADD |
Data Dictionary - Validation Rules |
N/A |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ELIGIBILITY-DETERMINANT-EFF-DATE. End date field: ELIGIBILITY-DETERMINANT-END-DATE |
|
08/30/2018
|
2.3.0 |
RULE-1964
|
UPDATE |
Data Dictionary - Validation Rules |
if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-RX has a valid, non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM
then for every record of type CLAIM-HEADER-RECORD-RX,
(there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR
(there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') |
DISPENSING-PRESCRIPTION-DRUG-PROV-NUM (CRX)
'if CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does not equal '585', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' |
|
01/18/2019
|
2.3.0 |
RULE-7186
|
ADD |
Data Dictionary - Validation Rules |
N/A |
The data elements SUBMITTING_STATE, ICN-ORIG , ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND should be unique across all records of type CLAIM-HEADER-RECORD-RX |
|
01/18/2019
|
2.3.0 |
RULE-7185
|
ADD |
Data Dictionary - Validation Rules |
N/A |
The data elements SUBMITTING_STATE, ICN-ORIG , ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND should be unique across all records of type CLAIM-HEADER-RECORD-OT |
|
01/18/2019
|
2.3.0 |
RULE-7184
|
ADD |
Data Dictionary - Validation Rules |
N/A |
The data elements SUBMITTING_STATE, ICN-ORIG , ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND should be unique across all records of type CLAIM-HEADER-RECORD-LT |
|
01/18/2019
|
2.3.0 |
RULE-7183
|
ADD |
Data Dictionary - Validation Rules |
N/A |
The data elements SUBMITTING_STATE, ICN-ORIG , ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND should be unique across all records of type CLAIM-HEADER-RECORD-IP |
|
02/01/2019
|
2.3.0 |
RULE-7190
|
ADD |
Data Dictionary - Validation Rules |
N/A |
The data elements SUBMITTING-STATE,ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND should be unique across all records of type CLAIM-LINE-RECORD-RX |
|
02/01/2019
|
2.3.0 |
RULE-7189
|
ADD |
Data Dictionary - Validation Rules |
N/A |
The data elements SUBMITTING-STATE,ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND should be unique across all records of type CLAIM-LINE-RECORD-OT |
|
02/01/2019
|
2.3.0 |
RULE-7188
|
ADD |
Data Dictionary - Validation Rules |
N/A |
The data elements SUBMITTING-STATE,ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND should be unique across all records of type CLAIM-LINE-RECORD-LT |
|
02/01/2019
|
2.3.0 |
RULE-7187
|
ADD |
Data Dictionary - Validation Rules |
N/A |
The data elements SUBMITTING-STATE,ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND should be unique across all records of type CLAIM-LINE-RECORD-IP |
|
08/30/2018
|
2.3.0 |
RULE-774
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND |
|
08/30/2018
|
2.3.0 |
RULE-1916
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: LINE-ADJUSTMENT-IND |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND |
|
08/30/2018
|
2.3.0 |
RULE-1616
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: LINE-ADJUSTMENT-IND |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND |
|
08/30/2018
|
2.3.0 |
RULE-1211
|
UPDATE |
Data Dictionary - Validation Rules |
If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND |
|
07/20/2018
|
2.3.0 |
RULE-1916
|
UPDATE |
Data Dictionary - Validation Rules |
LINE-ADJUSTMENT-IND (CRX)
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: LINE-ADJUSTMENT-IND |
LINE-ADJUSTMENT-IND (CRX)
If the field is populated, the value must be contained in the set of valid values with id: LINE-ADJUSTMENT-IND |
|
07/20/2018
|
2.3.0 |
RULE-1616
|
UPDATE |
Data Dictionary - Validation Rules |
LINE-ADJUSTMENT-IND (COT)
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: LINE-ADJUSTMENT-IND |
LINE-ADJUSTMENT-IND (COT)
If the field is populated, the value must be contained in the set of valid values with id: LINE-ADJUSTMENT-IND |
|
07/20/2018
|
2.3.0 |
RULE-1211
|
UPDATE |
Data Dictionary - Validation Rules |
LINE-ADJUSTMENT-IND (CLT)
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND |
LINE-ADJUSTMENT-IND (CLT)
If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND |
|
08/30/2018
|
2.3.0 |
RULE-689
|
UPDATE |
Data Dictionary - Validation Rules |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM
then for every record of type CLAIM-HEADER-RECORD-IP,
((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))
OR
(there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE,CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') AND CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE must in (PROV_IDENTIFIER_EFF_DATE, PROV_IDENTIFIER_END_DATE)))
Note: If CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE is NULL Then rule should not trigger. |
N/A |
|
08/30/2018
|
2.3.0 |
RULE-1845
|
UPDATE |
Data Dictionary - Validation Rules |
if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM
then for every record of type CLAIM-HEADER-RECORD-RX,
((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))
OR
(there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))) |
BILLING-PROV-NUM (CRX)
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' |
|
08/30/2018
|
2.3.0 |
RULE-1540
|
UPDATE |
Data Dictionary - Validation Rules |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NUM
then for every record of type CLAIM-HEADER-RECORD-OT,
((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))
OR
(there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-OT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') AND CLAIM-HEADER-RECORD-OT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))) |
N/A |
|
08/30/2018
|
2.3.0 |
RULE-1126
|
UPDATE |
Data Dictionary - Validation Rules |
if (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") OR CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-LT has a valid, non-null value for BILLING-PROV-NUM
then for every record of type CLAIM-HEADER-RECORD-LT,
((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))
OR
(there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER ), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))) |
N/A |
|
08/03/2018
|
2.3.0 |
RULE-689
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM
then for every record of type CLAIM-HEADER-RECORD-IP,
((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))
OR
(there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE,CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') AND CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE must in (PROV_IDENTIFIER_EFF_DATE, PROV_IDENTIFIER_END_DATE)))
Note: If CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE is NULL Then rule should not trigger. |
|
08/03/2018
|
2.3.0 |
RULE-1845
|
UPDATE |
Data Dictionary - Validation Rules |
BILLING-PROV-NUM (CRX)
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' |
if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM
then for every record of type CLAIM-HEADER-RECORD-RX,
((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))
OR
(there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))) |
|
08/03/2018
|
2.3.0 |
RULE-1540
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NUM
then for every record of type CLAIM-HEADER-RECORD-OT,
((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))
OR
(there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-OT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') AND CLAIM-HEADER-RECORD-OT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))) |
|
08/03/2018
|
2.3.0 |
RULE-1126
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") OR CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-LT has a valid, non-null value for BILLING-PROV-NUM
then for every record of type CLAIM-HEADER-RECORD-LT,
((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))
OR
(there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER ), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))) |
|
08/30/2018
|
2.3.0 |
RULE-810
|
UPDATE |
Data Dictionary - Validation Rules |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NUM
then for every record of type CLAIM-LINE-RECORD-IP,
(there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR
(there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') |
N/A |
|
08/30/2018
|
2.3.0 |
RULE-1663
|
UPDATE |
Data Dictionary - Validation Rules |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM
then for every record of type CLAIM-LINE-RECORD-OT,
(there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys () OR
(there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') |
N/A |
|
08/30/2018
|
2.3.0 |
RULE-1246
|
UPDATE |
Data Dictionary - Validation Rules |
if (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-LT has a valid, non-null value for SERVICING-PROV-NUM
then for every record of type CLAIM-LINE-RECORD-LT,
(there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR
(there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') |
SERVICING-PROV-NUM (CLT)
'if CLAIM-HEADER-RECORD-LT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' |
|
08/17/2018
|
2.3.0 |
RULE-810
|
UPDATE |
Data Dictionary - Validation Rules |
SERVICING-PROV-NUM (CIP)
'if CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NUM and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS does not equal '585', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NUM
then for every record of type CLAIM-LINE-RECORD-IP,
(there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR
(there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') |
|
08/17/2018
|
2.3.0 |
RULE-1964
|
UPDATE |
Data Dictionary - Validation Rules |
DISPENSING-PRESCRIPTION-DRUG-PROV-NUM (CRX)
'if CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does not equal '585', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' |
if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-RX has a valid, non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM then for every record of type CLAIM-HEADER-RECORD-RX,
(there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') |
|
08/17/2018
|
2.3.0 |
RULE-1663
|
UPDATE |
Data Dictionary - Validation Rules |
SERVICING-PROV-NUM (COT)
'if CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM and CLAIM-HEADER-RECORD-OT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does not equal '585', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM then for every record of type CLAIM-LINE-RECORD-OT, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys () OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') |
|
08/17/2018
|
2.3.0 |
RULE-1246
|
UPDATE |
Data Dictionary - Validation Rules |
SERVICING-PROV-NUM (CLT)
'if CLAIM-HEADER-RECORD-LT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys', where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' |
if (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-LT has a valid, non-null value for SERVICING-PROV-NUM then for every record of type CLAIM-LINE-RECORD-LT, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') |
|
08/30/2018
|
2.3.0 |
RULE-564
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM |
|
08/30/2018
|
2.3.0 |
RULE-1819
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM |
|
08/30/2018
|
2.3.0 |
RULE-1004
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM |
|
08/03/2018
|
2.3.0 |
RULE-564
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM |
|
08/03/2018
|
2.3.0 |
RULE-1819
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM |
|
08/03/2018
|
2.3.0 |
RULE-1004
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM |
|
08/30/2018
|
2.3.0 |
RULE-7192
|
UPDATE |
Data Dictionary - Validation Rules |
IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "2" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be equal to "3"
For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE <= ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data elements should be NOT NULL
VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,
VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and
ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
N/A |
|
08/30/2018
|
2.3.0 |
RULE-7191
|
UPDATE |
Data Dictionary - Validation Rules |
IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "1" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be in ("1","2")
For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE <= ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data elements should be NOT NULL
VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,
VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and
ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
N/A |
|
08/17/2018
|
2.3.0 |
RULE-7192
|
ADD |
Data Dictionary - Validation Rules |
N/A |
IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "2" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be equal to "3"
For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE <= ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data elements should be NOT NULL
VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,
VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and
ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
|
08/17/2018
|
2.3.0 |
RULE-7191
|
ADD |
Data Dictionary - Validation Rules |
N/A |
IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "1" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be in ("1","2")
For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE <= ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data elements should be NOT NULL
VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,
VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and
ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
|
08/30/2018
|
2.3.0 |
RULE-7197
|
UPDATE |
Data Dictionary - Validation Rules |
if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER has non null value
then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE, CLAIM-HEADER-RECORD-RX.MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE
Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail |
N/A |
|
08/30/2018
|
2.3.0 |
RULE-7196
|
UPDATE |
Data Dictionary - Validation Rules |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER has non null value
then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-OT. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-OT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE
Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail |
N/A |
|
08/30/2018
|
2.3.0 |
RULE-7195
|
UPDATE |
Data Dictionary - Validation Rules |
if (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER has non null value
then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-LT. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-LT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE
Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail |
N/A |
|
08/30/2018
|
2.3.0 |
RULE-7194
|
UPDATE |
Data Dictionary - Validation Rules |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER has non null value
then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE, CLAIM-HEADER-RECORD-IP. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE
Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail |
N/A |
|
08/17/2018
|
2.3.0 |
RULE-7197
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER has non null value
then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE, CLAIM-HEADER-RECORD-RX.MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE
Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail |
|
08/17/2018
|
2.3.0 |
RULE-7196
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER has non null value
then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-OT. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-OT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE
Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail |
|
08/17/2018
|
2.3.0 |
RULE-7195
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER has non null value
then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-LT. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-LT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE
Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail |
|
08/17/2018
|
2.3.0 |
RULE-7194
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER has non null value
then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE, CLAIM-HEADER-RECORD-IP. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE
Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail |
|
08/30/2018
|
2.3.0 |
RULE-7201
|
UPDATE |
Data Dictionary - Validation Rules |
if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER has non null value
then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE, CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE
Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail |
N/A |
|
08/30/2018
|
2.3.0 |
RULE-7200
|
UPDATE |
Data Dictionary - Validation Rules |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER has non null value
then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-OT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE
Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail |
N/A |
|
08/30/2018
|
2.3.0 |
RULE-7199
|
UPDATE |
Data Dictionary - Validation Rules |
if (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER has non null value
then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-LT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE
Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail |
N/A |
|
08/30/2018
|
2.3.0 |
RULE-7198
|
UPDATE |
Data Dictionary - Validation Rules |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER has non null value
then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-MAIN-MCR00002 that matches on the join keys (CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE, CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE
Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail |
N/A |
|
08/17/2018
|
2.3.0 |
RULE-7201
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER has non null value
then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE, CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE
Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail |
|
08/17/2018
|
2.3.0 |
RULE-7200
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER has non null value
then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-OT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE
Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail |
|
08/17/2018
|
2.3.0 |
RULE-7199
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER has non null value
then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-LT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE
Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail |
|
08/17/2018
|
2.3.0 |
RULE-7198
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER has non null value
then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-MAIN-MCR00002 that matches on the join keys (CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE, CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE
Note: See Tab 'DateRangeValidationCriteria' for date range criteria in detail |
|
11/23/2018
|
2.3.0 |
RULE-774
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND |
If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'.
Note: With this deployment, these are the valid values for LINE-ADJUSTMENT-IND:
0 – Original
1 – Void
4 – Debit Adjustment
5 –Credit Gross Adjustment
6 - Debit Gross Adjustment
The following valid values were removed from LINE-ADJUSTMENT-IND in Data Dictionary version 2.1 published November 2017. States should no longer report these valid values for (LINE-)ADJUSTMENT-IND.
2 - Resubmittal
3 – Credit Adjustment |
|
11/23/2018
|
2.3.0 |
RULE-564
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM |
'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM' |
|
11/23/2018
|
2.3.0 |
RULE-2165
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges (ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANT-END-DATE). |
|
11/23/2018
|
2.3.0 |
RULE-1916
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND |
If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'.
Note: With this deployment, these are the valid values for LINE-ADJUSTMENT-IND:
0 – Original
1 – Void
4 – Debit Adjustment
5 –Credit Gross Adjustment
6 - Debit Gross Adjustment
The following valid values were removed from LINE-ADJUSTMENT-IND in Data Dictionary version 2.1 published November 2017. States should no longer report these valid values for (LINE-)ADJUSTMENT-IND.
2 - Resubmittal
3 – Credit Adjustment |
|
11/23/2018
|
2.3.0 |
RULE-1819
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM |
'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'and CLAIM-HEADER-RECORD-RX has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM' |
|
11/23/2018
|
2.3.0 |
RULE-1616
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND |
If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'.
Note: With this deployment, these are the valid values for LINE-ADJUSTMENT-IND:
0 – Original
1 – Void
4 – Debit Adjustment
5 –Credit Gross Adjustment
6 - Debit Gross Adjustment
The following valid values were removed from LINE-ADJUSTMENT-IND in Data Dictionary version 2.1 published November 2017. States should no longer report these valid values for (LINE-)ADJUSTMENT-IND.
2 - Resubmittal
3 – Credit Adjustment |
|
11/23/2018
|
2.3.0 |
RULE-1211
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND |
If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND'.
Note: With this deployment, these are the valid values for LINE-ADJUSTMENT-IND:
0 – Original
1 – Void
4 – Debit Adjustment
5 –Credit Gross Adjustment
6 - Debit Gross Adjustment
The following valid values were removed from LINE-ADJUSTMENT-IND in Data Dictionary version 2.1 published November 2017. States should no longer report these valid values for (LINE-)ADJUSTMENT-IND.
2 - Resubmittal
3 – Credit Adjustment |
|
11/23/2018
|
2.3.0 |
RULE-1004
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM |
'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for PLAN-ID-NUMBER and CLAIM-HEADER-RECORD-LT has a valid, non-null value for BILLING-PROV-NUM and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM' |
|
11/23/2018
|
2.3.0 |
RULE-7201
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER has non null value; then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE, CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE |
|
11/23/2018
|
2.3.0 |
RULE-7200
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER has non null value; then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-OT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE |
|
11/23/2018
|
2.3.0 |
RULE-7199
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER has non null value; then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-LT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE |
|
11/23/2018
|
2.3.0 |
RULE-7198
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER has non null value; then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-MAIN-MCR00002 that matches on the join keys (CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE, CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER with MANAGED-CARE-MAIN-MCR00002.SUBMITTING-STATE, MANAGED-CARE-MAIN-MCR00002.STATE-PLAN-ID-NUM) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-MAIN-MCR00002.MANAGED-CARE-CONTRACT-END-DATE |
|
11/23/2018
|
2.3.0 |
RULE-7197
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER has non null value; then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE, CLAIM-HEADER-RECORD-RX.MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-RX.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE |
|
11/23/2018
|
2.3.0 |
RULE-7196
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER has non null value; then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-OT. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-OT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE |
|
11/23/2018
|
2.3.0 |
RULE-7195
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER has non null value; then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE, CLAIM-HEADER-RECORD-LT. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-LT.BEGINING-DATE-OF-SERVICE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE |
|
11/23/2018
|
2.3.0 |
RULE-7194
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (Z) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN (("26","026","87","087", "542","585", "654")) AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM IN (3, C, W, 2, B, V) AND CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER has non null value; then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type MANAGED-CARE-PARTICIPATION-ELG00014 that matches on the join keys (CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE, CLAIM-HEADER-RECORD-IP. MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-IP.PLAN-ID-NUMBER with MANAGED-CARE-PARTICIPATION-ELG00014.SUBMITTING-STATE, MANAGED-CARE-PARTICIPATION-ELG00014.MSIS-IDENTIFICATION-NUM, MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ID) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION-ELG00014.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE |
|
11/23/2018
|
2.3.0 |
RULE-7192
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "2" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be equal to "3". For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE <= ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data elements should be NOT NULL
VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,
VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and
ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
|
11/23/2018
|
2.3.0 |
RULE-7191
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
IF ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-TYPE = "1" Then VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE must be in ("1","2"). For every record of type ENROLLMENT-TIME-SPAN-SEGMENT, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE >= ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE <= ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data elements should be NOT NULL
VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE,
VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and
ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
|
12/21/2018
|
2.3.0 |
RULE-884
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
Date check on CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE |
if (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data element should be NOT NULL
SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM,
CLAIM-HEADER-RECORD-LT.BEGINNING-DATE-OF-SERVICE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and
ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
|
12/21/2018
|
2.3.0 |
RULE-335
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
Date check on CLAIM-HEADER-RECORD-IP.ADMISSION-DATE and CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-IP, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys (SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-IP.ADMISSION-DATE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data element should be NOT NULL
SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM,
CLAIM-HEADER-RECORD-IP.ADMISSION-DATE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and
ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
|
12/21/2018
|
2.3.0 |
RULE-3060
|
UPDATE |
Data Dictionary - Validation Rules |
record TPL-MEDICAID-ELIGIBLE-PERSON-MAIN has corresponding parent record PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
N/A |
|
12/21/2018
|
2.3.0 |
RULE-1758
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
Date check on Date check on CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) OR CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data element should be NOT NULL
SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM,
CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and
ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
|
12/21/2018
|
2.3.0 |
RULE-1337
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
Date check on CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.END-DATE-OF-SERVICE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data element should be NOT NULL
SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM,
CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE,
ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and
ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
|
12/21/2018
|
2.3.0 |
RULE-810
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NUM then for every record of type CLAIM-LINE-RECORD-IP, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') |
|
12/21/2018
|
2.3.0 |
RULE-689
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-IP has a valid, non-null value for BILLING-PROV-NUM
then for every record of type CLAIM-HEADER-RECORD-IP,
((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))
OR
(there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-IP.SUBMITTING-STATE,CLAIM-HEADER-RECORD-IP.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') AND CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE must in (PROV_IDENTIFIER_EFF_DATE, PROV_IDENTIFIER_END_DATE)))
Note: If CLAIM-HEADER-RECORD-IP.DISCHARGE_DATE is NULL Then rule should not trigger. |
|
12/21/2018
|
2.3.0 |
RULE-1964
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-RX has a valid, non-null value for DISPENSING-PRESCRIPTION-DRUG-PROV-NUM then for every record of type CLAIM-HEADER-RECORD-RX, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') |
|
12/21/2018
|
2.3.0 |
RULE-1845
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-RX.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-RX has a valid, non-null value for BILLING-PROV-NUM
then for every record of type CLAIM-HEADER-RECORD-RX,
((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))
OR
(there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' AND CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))) |
|
12/21/2018
|
2.3.0 |
RULE-1663
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-OT has a valid, non-null value for SERVICING-PROV-NUM then for every record of type CLAIM-LINE-RECORD-OT, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys () OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') |
|
12/21/2018
|
2.3.0 |
RULE-1540
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NUM
then for every record of type CLAIM-HEADER-RECORD-OT,
((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE,CLAIM-HEADER-RECORD-RX.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))
OR
(there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys ((CLAIM-HEADER-RECORD-OT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-OT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER )), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') AND CLAIM-HEADER-RECORD-OT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))) |
|
12/21/2018
|
2.3.0 |
RULE-1246
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") AND CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654") AND CLAIM-LINE-RECORD-LT has a valid, non-null value for SERVICING-PROV-NUM then for every record of type CLAIM-LINE-RECORD-LT, (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys) OR (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1') |
|
12/21/2018
|
2.3.0 |
RULE-1126
|
UPDATE |
Data Dictionary - Validation Rules |
N/A |
if (CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM NOT IN ('Z','3','C','W',"2","B","V"," 4","D","X") OR CLAIM-HEADER-RECORD-LT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) AND CLAIM-HEADER-RECORD-LT has a valid, non-null value for BILLING-PROV-NUM
then for every record of type CLAIM-HEADER-RECORD-LT,
((there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN. SUBMITTING-STATE-PROV-ID ) AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))
OR
(there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys (CLAIM-HEADER-RECORD-LT.SUBMITTING-STATE,CLAIM-HEADER-RECORD-LT.BILLING-PROV-NUM with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE,PROV-ATTRIBUTES-MAIN.PROV-IDENTIFIER ), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' AND CLAIM-HEADER-RECORD-LT.END-DATE-OF-SERVICE must in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE))) |
|
02/22/2019
|
2.3.0 |
RULE-487
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-6 and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-6 is less than or equal to CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE |
N/A |
|
02/22/2019
|
2.3.0 |
RULE-475
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-5 and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-5 is less than or equal to CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE |
N/A |
|
02/22/2019
|
2.3.0 |
RULE-462
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-4 and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-4 is less than or equal to CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE |
N/A |
|
02/22/2019
|
2.3.0 |
RULE-448
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-3 and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-3 is less than or equal to CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE |
N/A |
|
02/22/2019
|
2.3.0 |
RULE-435
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-2 and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-2 is less than or equal to CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE |
N/A |
|
02/22/2019
|
2.3.0 |
RULE-422
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-1 and CLAIM-LINE-RECORD-IP has a valid, non-null value for ENDING-DATE-OF-SERVICE, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-1 is less than or equal to CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE' |
N/A |
|
01/18/2019
|
2.3.0 |
RULE-1423
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '122', then CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-OT.BILLING-PROV-NUM |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '122', then CLAIM-HEADER-RECORD-OT.PLAN-ID-NUMBER equals CLAIM-HEADER-RECORD-OT.BILLING-PROV-NUM |
|
03/01/2019
|
2.3.0 |
RULE-1390
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X', then CLAIM-HEADER-RECORD-OT.TOT-BILLED-AMT equals '0.00' |
N/A |
|
04/12/2019
|
2.3.0 |
RULE-7203
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'If CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') then If the field is populated and 5th and 6th character value is not null, then 5th and 6th character value must be contained in the set of valid values with id: 'DRUG-UTILIZATION-CODE-E6'' |
|
04/12/2019
|
2.3.0 |
RULE-7202
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'If CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') then If the field is populated and 3rd and 4th character value is not null, then 3rd and 4th character value must be contained in the set of valid values with id: 'DRUG-UTILIZATION-CODE-E5'' |
|
04/12/2019
|
2.3.0 |
RULE-1948
|
ADD |
Data Dictionary - Validation Rules |
N/A |
If CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') then If the field is populated and 1st and 2nd character value is not null, then 1st and 2nd character value must be contained in the set of valid values with id: 'DRUG-UTILIZATION-CODE-E4'' |
|
03/15/2019
|
2.3.0 |
RULE-824
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '0', '1', '2', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02' |
If CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02' |
|
03/15/2019
|
2.3.0 |
RULE-1955
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '0', '1', '2', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02' |
If CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02' |
|
03/15/2019
|
2.3.0 |
RULE-1691
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'
and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654'
and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '0', '1', '2',
then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02' |
|
03/15/2019
|
2.3.0 |
RULE-1256
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '0', '1', '2', then CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02' |
If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02' |
|
04/19/2019
|
2.3.0 |
RULE-2165
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ELIGIBILITY-DETERMINANT-EFF-DATE. End date field: ELIGIBILITY-DETERMINANT-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges (ELIGIBILITY-DETERMINANT.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE and ELIGIBILITY-DETERMINANT.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE). |
|
04/19/2019
|
2.3.0 |
RULE-2105
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ELIGIBLE-ADDR-EFF-DATE. End date field: ELIGIBLE-ADDR-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ELIGIBLE-CONTACT-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: ELIGIBLE-CONTACT-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2071
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE. End date field: VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: VARIABLE-DEMOGRAPHIC-ELIGIBILITY.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: VARIABLE-DEMOGRAPHIC-ELIGIBILITY.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2028
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE. End date field: PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PRIMARY-DEMOGRAPHICS-ELIGIBILITY.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PRIMARY-DEMOGRAPHICS-ELIGIBILITY.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2263
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: LOCKIN-EFF-DATE. End date field: LOCKIN-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: LOCK-IN-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: LOCK-IN-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2241
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: HEALTH-HOME-CHRONIC-CONDITION-EFF-DATE. End date field: HEALTH-HOME-CHRONIC-CONDITION-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: HEALTH-HOME-CHRONIC-CONDITIONS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: HEALTH-HOME-CHRONIC-CONDITIONS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2217
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: HEALTH-HOME-SPA-PROVIDER-EFF-DATE. End date field: HEALTH-HOME-SPA-PROVIDER-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: HEALTH-HOME-SPA-PROVIDER.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: HEALTH-HOME-SPA-PROVIDER.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2188
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: HEALTH-HOME-SPA-PARTICIPATION-EFF-DATE. End date field: HEALTH-HOME-SPA-PARTICIPATION-END-DATE, |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: HEALTH-HOME-SPA-PARTICIPATION-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: HEALTH-HOME-SPA-PARTICIPATION-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2361
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: LTSS-ELIGIBILITY-EFF-DATE. End date field: LTSS-ELIGIBILITY-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: LTSS-PARTICIPATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: LTSS-PARTICIPATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2338
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: WAIVER-ENROLLMENT-EFF-DATE. End date field: WAIVER-ENROLLMENT-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: WAIVER-PARTICIPATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: WAIVER-PARTICIPATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2313
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: STATE-PLAN-OPTION-EFF-DATE. End date field: STATE-PLAN-OPTION-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: STATE-PLAN-OPTION-PARTICIPATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: STATE-PLAN-OPTION-PARTICIPATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2289
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MFP-ENROLLMENT-EFF-DATE. End date field: MFP-ENROLLMENT-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MFP-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: MFP-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2458
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: DISABILITY-TYPE-EFF-DATE. End date field: DISABILITY-TYPE-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: DISABILITY-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: DISABILITY-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2438
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: RACE-DECLARATION-EFF-DATE. End date field: RACE-DECLARATION-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: RACE-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: RACE-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2413
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ETHNICITY-DECLARATION-EFF-DATE. End date field: ETHNICITY-DECLARATION-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ETHNICITY-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: ETHNICITY-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2392
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE. End date field: MANAGED-CARE-PLAN-ENROLLMENT-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-PARTICIPATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: MANAGED-CARE-PARTICIPATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2519
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ENROLLMENT-EFF-DATE. End date field: ENROLLMENT-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ENROLLMENT-TIME-SPAN-SEGMENT.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: ENROLLMENT-TIME-SPAN-SEGMENT.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2498
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-EFF-DATE. End date field: HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2478
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: 1115A-EFF-DATE. End date field: 1115A-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: 1115A-DEMONSTRATION-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: 1115A-DEMONSTRATION-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/12/2019
|
2.3.0 |
RULE-2950
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-MEDICAID-EFF-DATE. End date field: PROV-MEDICAID-END-DATE |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-MEDICAID-ENROLLMENT.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-MEDICAID-ENROLLMENT.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2911
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-IDENTIFIER-EFF-DATE. End date field: PROV-IDENTIFIER-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-IDENTIFIERS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-IDENTIFIERS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2878
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-LICENSE-EFF-DATE. End date field: PROV-LICENSE-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-LICENSE-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-LICENSE-INFOR.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2841
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE. End date field: PROV-LOCATION-AND-CONTACT-INFO-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-LOCATION-AND-CONTACT-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-LOCATION-AND-CONTACT-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2793
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-ATTRIBUTES-EFF-DATE. End date field: PROV-ATTRIBUTES-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-ATTRIBUTES-MAIN.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-ATTRIBUTES-MAIN.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-3016
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: BED-TYPE-EFF-DATE. End date field: BED-TYPE-END-DATE |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-BED-TYPE-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-BED-TYPE-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2996
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-AFFILIATED-PROGRAM-EFF-DATE. End date field: PROV-AFFILIATED-PROGRAM-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-AFFILIATED-PROGRAMS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-AFFILIATED-PROGRAMS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2974
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-AFFILIATED-GROUP-EFF-DATE. End date field: PROV-AFFILIATED-GROUP-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-AFFILIATED-GROUPS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-AFFILIATED-GROUPS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2950
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-MEDICAID-EFF-DATE. End date field: PROV-MEDICAID-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-MEDICAID-ENROLLMENT.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-MEDICAID-ENROLLMENT.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2932
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-TAXONOMY-CLASSIFICATION-EFF-DATE. End date field: PROV-TAXONOMY-CLASSIFICATION-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: PROV-TAXONOMY-CLASSIFICATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: PROV-TAXONOMY-CLASSIFICATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2659
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-OP-AUTHORITY-EFF-DATE. End date field: MANAGED-CARE-OP-AUTHORITY-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-OPERATING-AUTHORITY.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: MANAGED-CARE-OPERATING-AUTHORITY.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2636
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-SERVICE-AREA-EFF-DATE. End date field: MANAGED-CARE-SERVICE-AREA-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-SERVICE-AREA.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: MANAGED-CARE-SERVICE-AREA.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2598
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE. End date field: MANAGED-CARE-LOCATION-AND-CONTACT-INFO-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-LOCATION-AND-CONTACT-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: MANAGED-CARE-LOCATION-AND-CONTACT-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2578
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-MAIN-REC-EFF-DATE. End date field: MANAGED-CARE-MAIN-REC-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-MAIN.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: MANAGED-CARE-MAIN.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2750
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: CHPID-SHPID-RELATIONSHIP-EFF-DATE. End date field: CHPID-SHPID-RELATIONSHIP-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: CHPID-SHPID-RELATIONSHIPS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: CHPID-SHPID-RELATIONSHIPS.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2726
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-EFF-DATE. End date field: NATIONAL-HEALTH-CARE-ENTITY-ID-INFO-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: NATIONAL-HEALTH-CARE-ENTITY-ID.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: NATIONAL-HEALTH-CARE-ENTITY-ID-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2701
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: DATE-ACCREDITATION-ACHIEVED. End date field: DATE-ACCREDITATION-END. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-ACCREDITATION-ORGANIZATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: MANAGED-CARE-ACCREDITATION-ORGANIZATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-2680
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-PLAN-POP-EFF-DATE. End date field: MANAGED-CARE-PLAN-POP-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: MANAGED-CARE-PLAN-POPULATION-ENROLLED.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: MANAGED-CARE-PLAN-POPULATION-ENROLLED.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-3127
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: INSURANCE-CATEGORIES-EFF-DATE. End date field: INSURANCE-CATEGORIES-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-3103
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: INSURANCE-COVERAGE-EFF-DATE. End date field: INSURANCE-COVERAGE-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-3070
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: ELIG-PRSN-MAIN-EFF-DATE. End date field: ELIG-PRSN-MAIN-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: TPL-MEDICAID-ELIGIBLE-PERSON-MAIN.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-3176
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: TPL-ENTITY-CONTACT-INFO-EFF-DATE. End date field: TPL-ENTITY-CONTACT-INFO-END-DATE., |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: TPL-ENTITY-CONTACT-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: TPL-ENTITY-CONTACT-INFORMATIONTPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
04/19/2019
|
2.3.0 |
RULE-3148
|
UPDATE |
Data Dictionary - Validation Rules |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: OTHER-TPL-EFF-DATE. End date field: OTHER-TPL-END-DATE. |
Records with the same primary keys (excluding any date fields) must have non-overlapping date ranges. Effective date field: TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-START-DATE. End date field: TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION.STATE-SUBMITTED-SEGMENT-EFFECTIVE-PERIOD-END-DATE. |
|
05/10/2019
|
2.3.0 |
RULE-7207
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'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.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1' then CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01' |
|
05/10/2019
|
2.3.0 |
RULE-7206
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'If CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1' then CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01' |
|
05/10/2019
|
2.3.0 |
RULE-7205
|
ADD |
Data Dictionary - Validation Rules |
N/A |
''If CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1' then CLAIM-LINE-RECORD-IP.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01' |
|
05/10/2019
|
2.3.0 |
RULE-7204
|
ADD |
Data Dictionary - Validation Rules |
N/A |
'If CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does NOT equal ‘F2’ and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does NOT equal ‘0’ and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS does NOT equal to ('26', '87', '542', '585', '654') and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does NOT equal 'Z' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does NOT equal ('26', '87', '542', '585', '654') and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to '1' then CLAIM-LINE-RECORD-OT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01' |
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