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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-LINE-RECORD-OT.PROCEDURE-CODE-MOD-4 |
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', then If the PROCEDURE-CODE-MOD-4 field is populated, the value must be contained in the set of valid values with id: 'PROCEDURE-CODE-MOD' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
Rule Definition | If the procedure mod 4 is populated on a non-denied claim line from an OT file, then the procedure mod 4 value reported must be in the list of valid values for procedure mod 4. |
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.PROCEDURE-CODE-MOD-4 equal to a valid, non-null value |