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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.COPAY-WAIVED-IND |
Validation Logic | 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the COPAY-WAIVED-IND field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-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)' |
Rule Definition | If the copay waiver indicator is populated on a non-denied claim from an LT file, then the copay waiver indicator reported must be found in the list of valid values. |
Denominator Logic | # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' |