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Tier | 2.0 |
---|---|
Tier Description | Relational error |
Error Category | E2002 |
Error Category Message | Values inconsistently specified (single record type, multiple records) |
Rule Type | Two Record Type (1 to 1) |
File Segment Number | CLT00002 |
Data Element Name | CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE |
Validation Logic | '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'' |
Rule Definition | If the type of service is populated on a non-denied claim line from an LT file, then the type of service must be from a valid list of values for long-term care services: '009', '044', '045', '046', '047', '048', '050', '059', '133', '136', '137', '146', '147'. |
Denominator Logic | # of LT claim lines with CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and with CLAIM-LINE-RECORD-LT has a non-null value for TYPE-OF-SERVICE and with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' |