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Tier | 3.0 |
---|---|
Tier Description | Relational error |
Error Category | E3002 |
Error Category Message | Values inconsistently specified (multiple record types, multi file) |
Rule Type | Three Record Type Rule |
File Segment Number | ELG00003 |
Data Element Name | CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT |
Validation Logic | 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is not equal to one of the following: 'Z', '3', 'C', 'W' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE is equal to one of the following: '2', '3', then CLAIM-LINE-RECORD-LT.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '02'' |
Rule Definition | If a claim is a non-denied claim from an LT file and the variable demographics eligibility chip code is equal to '2' or '3', then the claim line has a CMS-64 category of federal reimbursement equal to '02'. |
Denominator Logic | # of LT claim lines with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR not equal to '0' and with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS not in: '26', '87', '542', '585', '654' and with CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM not in: 'Z', '3', 'C', 'W' and with CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' and with VARIABLE-DEMOGRAPHICS-ELIGIBILITY.CHIP-CODE equals: '2', '3' |