RULE-1938

Tier	2.0
Tier Description	Relational error
Error Category	E2002
Error Category Message	Values inconsistently specified (single record type, multiple records)
Rule Type	Two Record Type (1 to 1)
File Segment Number	CRX00002
Data Element Name	CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE
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 has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '011', '018', '033', '034', '036', '085', '089', '127', '131', '136', '137', '145''
Rule Definition	If the type of service is populated on a non-denied claim line from an RX file, then the type of service must be from a valid list of values for pharmacy services: '011', '018', '033', '034', '036', '085', '089', '127', '131', '136', '137', '145' (e.g., prescribed drugs, medical equipment, family planning supplies).
Denominator Logic	# of RX claim lines with CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS not in '26', '87', '542', '585', '654' AND with CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE valid, non-null AND with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2'

Published Date	Data Guide Version	Validation Rule	Action	Field	Before	After
08/21/2020	2.4.0	RULE-1938	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. '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 has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '011', '018', '033', '034', '036', '085', '089', '127', '131', '136', '137''
04/17/2020	2.4.0	RULE-1938	UPDATE	Data Dictionary - Validation Rules	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 has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '011', '018', '033', '034', '036', '085', '089', '127', '131''	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 has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '011', '018', '033', '034', '036', '085', '089', '127', '131','136','137''
12/17/2021	3.0.0	RULE-1938	UPDATE	Data Dictionary - Validation Rules	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 has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '011', '018', '033', '034', '036', '085', '089', '127', '131', '136', '137''	‘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 has a valid, non-null value for TYPE-OF-SERVICE and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX.TYPE-OF-SERVICE is equal to one of the following: '011', '018', '033', '034', '036', '085', '089', '127', '131', '136', '137', '145’'