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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-LINE-RECORD-LT.LINE-ADJUSTMENT-REASON-CODE |
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', then If the LINE-ADJUSTMENT-REASON-CODE 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)' |
Rule Definition | If the line adjustment reason code is populated on a non-denied claim from an LT file, then the line adjustment reason code value reported must be in the list of valid values. |
Denominator Logic | # of LT claim lines 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.ADJUSTMENT-REASON-CODE equal to a valid, non-null value |