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Tier | 2.0 |
---|---|
Tier Description | Relational error |
Error Category | E2001 |
Error Category Message | Values inconsistently specified (single record type, single record) |
Rule Type | One Record Type (Single Record) |
File Segment Number | CRX00002 |
Data Element Name | CLAIM-HEADER-RECORD-RX.WAIVER-TYPE |
Validation Logic | 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.PROGRAM-TYPE equals '07', then CLAIM-HEADER-RECORD-RX.WAIVER-TYPE is equal to one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20', '33'' |
Rule Definition | If the program type is HCBS on a non-denied claim from an RX file, then the waiver type value reported must be one of the following: '06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20', '33'. |
Denominator Logic | # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' AND CLAIM-HEADER-RECORD-RX.PROGRAM-TYPE equal to '07' |