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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 | Three Record Type Rule |
File Segment Number | CLT00002 |
Data Element Name | CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE • FILE-HEADER-RECORD-LT.END-OF-TIME-PERIOD |
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.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-LT has a valid, non-null value for ADJUDICATION-DATE and FILE-HEADER-RECORD-LT has a valid, non-null value for END-OF-TIME-PERIOD and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE is less than or equal to FILE-HEADER-RECORD-LT.END-OF-TIME-PERIOD' |
Rule Definition | If adjudication date is populated on a non-denied claim line from an LT file that is not a capitated payment or premium payment and end of time period is populated on the file header, then the adjudication date value reported must be before or equal to the end of time period value reported. |
Denominator Logic | # of LT claim lines with CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' AND with CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE not in: '119', '120', '121', '122' AND with CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE equal to a valid, non-null value AND with FILE-HEADER-RECORD-LT.END-OF-TIME-PERIOD equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' |