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Tier | 1.1 |
---|---|
Tier Description | Value Error |
Error Category | E1103 |
Error Category Message | Value not in specified valid value set |
Rule Type | Valid Value |
File Segment Number | CLT00002 |
Data Element Name | CLAIM-HEADER-RECORD-LT.OCCURRENCE-CODE-05 |
Validation Logic | 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the OCCURRENCE-CODE-05 field is populated, the value must be contained in the set of valid values with id: 'OCCURRENCE-CODE' 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)' |
Rule Definition | If the occurrence code 05 is populated on a non-denied claim from an LT file, then the occurrence code 05 value reported must be in the list of valid values for 'occurrence code'. |
Denominator Logic | # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-LT.OCCURRENCE-CODE-05 equal to a valid, non-null value |