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Tier | 1.1 |
---|---|
Tier Description | Value Error |
Error Category | E1102 |
Error Category Message | Value does not match specification |
Rule Type | Two Record Type (1 to 1) |
File Segment Number | COT00002 |
Data Element Name | CLAIM-LINE-RECORD-OT.NATIONAL-DRUG-CODE |
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 CLAIM-LINE-RECORD-OT has a valid, non-null value for NATIONAL-DRUG-CODE, then CLAIM-LINE-RECORD-OT.NATIONAL-DRUG-CODE is a valid National Drug Code (NDC) value' |
Rule Definition | If the national drug code is populated on a non-denied OT claim line, then the national drug code value reported must be in the list of valid values. |
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 CLAIM-LINE-RECORD-OT.NATIONAL-DRUG-CODE equal to a valid, non-null value |