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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.CLAIM-DENIED-INDICATOR |
Validation Logic | 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM equals 'Z', then CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR equals '0'' |
Rule Definition | If the claim status category or the type of claim is for denied claims on a claim from an OT file, the claim denied indicator value reported must also indicate the claim is denied. |
Denominator Logic | # of OT claim headers with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY equal to 'F2' OR with CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM equal to 'Z' |