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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 | CRX00002 |
Data Element Name | CLAIM-HEADER-RECORD-RX.CLAIM-PYMT-REM-CODE-2 |
Validation Logic | 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the CLAIM-PYMT-REM-CODE-2 field is populated, the value must be contained in the set of valid values with id: 'CLAIM-PYMT-REM-CODE' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
Rule Definition | If the claim payment rem code 2 is populated on a non-denied claim from an RX file, then the claim payment rem code 2 reported must be found in the list of valid values. |
Denominator Logic | # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-RX.CLAIM-PYMT-REM-CODE equal to a valid, non-nulll value |