01/27/2021
|
3.0.0 |
RULE-1337
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z', 'U', 'V', 'Y', 'W' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654','686' then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys |
08/30/2018
|
2.3.0 |
RULE-1337
|
UPDATE |
Data Dictionary - Validation Rules |
If (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data element should be NOT NULL SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
Date check on CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.END-DATE-OF-SERVICE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE |
07/06/2018
|
2.3.0 |
RULE-1337
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
Date check on CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.END-DATE-OF-SERVICE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE |
If (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data element should be NOT NULL SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |
12/21/2018
|
2.3.0 |
RULE-1337
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then for every record of type CLAIM-HEADER-RECORD-LT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys
Date check on CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-OT.END-DATE-OF-SERVICE with PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE |
if (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0' AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN (4, D, X, Z, U, V, Y, W) AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654")) then for every record of type CLAIM-HEADER-RECORD-OT, there must be a valid record of type ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM) AND CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE BETWEEN ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE
Note: The following data element should be NOT NULL SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM, CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE, ENROLLMENT-TIME-SPAN-SEGMENT.EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.END-DATE |