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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.MEDICARE-HIC-NUM |
Validation Logic | 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-RX has a null or invalid value for MEDICARE-BENEFICIARY-IDENTIFIER, then CLAIM-HEADER-RECORD-RX has a valid, non-null value for MEDICARE-HIC-NUM' |
Rule Definition | If a non-denied, crossover RX claim has a value populated for medicare beneficiary ID, the RX claim must have a value populated for medicare hic number. |
Denominator Logic | # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equal to '1' and with CLAIM-HEADER-RECORD-RX.MEDICARE-BENEFICIARY-IDENTIFIER equal to a null or invalid value |