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Tier | 2.1 |
---|---|
Tier Description | Relational error |
Error Category | E2102 |
Error Category Message | Values inconsistently specified (multi record, single file) |
Rule Type | Two Record Type (1 to 1) |
File Segment Number | CRX00002 |
Data Element Name | CLAIM-LINE-RECORD-RX.LINE-NUM-ADJ |
Validation Logic | 'if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX has a null or invalid value for LINE-NUM-ADJ' |
Rule Definition | If the line adjustment indicator is for an original claim on a non-denied claim from an RX file, then the adjustment line number must not be populated. |
Denominator Logic | # of RX claim lines with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS not in '26', '87', '542', '585', '654' AND with CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-INT equals '0' |