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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 | ELG00011 |
Data Element Name | STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-TYPE |
Validation Logic | 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.PROGRAM-TYPE equals '13', then STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-TYPE equals '02'' |
Rule Definition | If a non-denied RX claim has a program type of (13) HCBS State Plan Option 1915(i), then the state plan option participation ELG file must have a state plan option type equal to '02'. |
Denominator Logic | # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-RX.PROGRAM-TYPE equal to '13' |