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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.PLAN-ID-NUMBER |
Validation Logic | 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W', then CLAIM-HEADER-RECORD-RX has a null or invalid value for PLAN-ID-NUMBER' |
Rule Definition | If a claim is a non-denied non-encounter claim from an RX file, then the plan ID must be null. |
Denominator Logic | # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM not in '3', 'C', 'W' |