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Tier | 2.0 |
---|---|
Tier Description | Relational error |
Error Category | E2001 |
Error Category Message | Values inconsistently specified (single record type, single record) |
Rule Type | One Record Type (Single Record) |
File Segment Number | COT00002 |
Data Element Name | CLAIM-HEADER-RECORD-OT.HEALTH-HOME-PROV-IND |
Validation Logic | 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for HEALTH-HOME-ENTITY-NAME, then CLAIM-HEADER-RECORD-OT.HEALTH-HOME-PROV-IND equals '1'' |
Rule Definition | If a non-denied OT claim has a value populated for the health home entity name, then the health home provider indicator must be equal to '1'. |
Denominator Logic | # of OT claim headers with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-OT.HEALTH-HOME-ENTITY-NAME equal to a valid, non-null value |