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Tier | 2.1 |
---|---|
Tier Description | Relational error |
Error Category | E2102 |
Error Category Message | Values inconsistently specified (multi record, single file) |
Rule Type | Two Record Type (1 to 1) |
File Segment Number | CLT00002 |
Data Element Name | CLAIM-HEADER-RECORD-LT.ICF-IID-DAYS |
Validation Logic | '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' |
Rule Definition | If type of service is intermediate care facility (ICF/IIDICF/IID) services on a non-denied claim line from an LT file, then ICF IID days must be populated on the claim. |
Denominator Logic | # of LT claims with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' AND with CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE equal to '046' |