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Tier | 1.1 |
---|---|
Tier Description | Value Error |
Error Category | E1102 |
Error Category Message | Value does not match specification |
Rule Type | Two Record Type (1 to 1) |
File Segment Number | CRX00002 |
Data Element Name | CLAIM-LINE-RECORD-RX.DAYS-SUPPLY |
Validation Logic | 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and 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 DAYS-SUPPLY, then CLAIM-LINE-RECORD-RX.DAYS-SUPPLY is greater than or equal to -365 AND less than or equal to 365' |
Rule Definition | If the days supply is populated on a non-denied claim line from an RX file, then the days supply value reported must greater than or equal to -365 and less than or equal to 365. |
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.DAYS-SUPPLY equal to a valid, non-null value |