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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 | Two Record Type (1 to 1) |
File Segment Number | ELG00018 |
Data Element Name | CLAIM-HEADER-RECORD-RX.1115A-DEMONSTRATION-IND |
Validation Logic | 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and (1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equals '0' or 1115A-DEMONSTRATION-INFORMATION has a null or invalid value for 1115A-DEMONSTRATION-IND), then CLAIM-HEADER-RECORD-RX.1115A-DEMONSTRATION-IND equals '0' or CLAIM-HEADER-RECORD-RX has a null or invalid value for 1115A-DEMONSTRATION-IND' |
Rule Definition | If the 1115A demonstration information segment indicates an individual does not participate in an 1115A demonstration, then the non-denied RX claim must not have a value populated for the 1115A demonstration indicator. |
Denominator Logic | # of RX claim headers with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with 1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equals to '0' or with 1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equal to a null or invalid value |