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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 | COT00002 |
Data Element Name | CLAIM-HEADER-RECORD-OT.CLAIM-PYMT-REM-CODE-4 |
Validation Logic | 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the CLAIM-PYMT-REM-CODE-4 field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
Rule Definition | If the claim payment rem code 4 is populated on a non-denied claim from an OT file, then the claim payment rem code 4 reported must be found in the list of valid values. |
Denominator Logic | # of OT claim headers with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-OT.CLAIM-PYMT-REM-CODE equal to a valid, non-null value |