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Tier | 3.0 |
---|---|
Tier Description | Relational error |
Error Category | E3002 |
Error Category Message | Values inconsistently specified (multiple record types, multi file) |
Rule Type | Three Record Type Rule |
File Segment Number | ELG00002 |
Data Element Name | PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH • CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-DATE |
Validation Logic | 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-LINE-RECORD-OT has a valid, non-null value for PROCEDURE-CODE-DATE, then CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH' |
Rule Definition | If a non-denied OT claim has a value populated for procedure code date and the primary demographics eligibility segment has a value populated for date of death, the OT claim procedure code date must be less than oe equal to the primary demographics eligibility segment date of death. |
Denominator Logic | # of OT claim lines with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' and with PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH equal to a valid, non-null value and with CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-DATE equal to a valid, non-null value |