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Tier | 1.1 |
---|---|
Tier Description | Value Error |
Error Category | E1102 |
Error Category Message | Value does not match specification |
Rule Type | One Record Type (Single Record) |
File Segment Number | CRX00002 |
Data Element Name | CLAIM-HEADER-RECORD-RX.ELIGIBLE-MIDDLE-INIT |
Validation Logic | 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for ELIGIBLE-MIDDLE-INIT, then CLAIM-HEADER-RECORD-RX.ELIGIBLE-MIDDLE-INIT does not contain any pipe (|) or asterisk (*) characters' |
Rule Definition | If the eligible middle name is populated on a non-denied claim from an RX file, then the eligible middle name reported must not contain any pipe or asterisk characters. |
Denominator Logic | # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-RX.ELIGIBLE-MIDDLE-INIT equal to a valid, non-null value |