RULE-511

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Tier	1.1
Tier Description	Value Error
Error Category	E1103
Error Category Message	Value not in specified valid value set
Rule Type	Valid Value
File Segment Number	CIP00002
Data Element Name	CLAIM-HEADER-RECORD-IP.TYPE-OF-BILL
Validation Logic	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-IP.TYPE-OF-BILL is a valid type of bill code'
Rule Definition	If type of bill is populated on a non-denied claim from an IP file, then the type of bill value reported must be in the list of valid values for type of bill.
Denominator Logic	# of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-IP.TYPE-OF-BILL equal to a valid, non-null value

Published Date	Data Guide Version	Validation Rule	Action	Field	Before	After
01/31/2020	2.4.0	RULE-511	UPDATE	Data Dictionary - Validation Rules	'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-IP.TYPE-OF-BILL is a valid type of bill code'	if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TYPE-OF-BILL, then CLAIM-HEADER-RECORD-IP.TYPE-OF-BILL is a valid type of bill code and ((CLAIM-HEADER.DISCHARGE-DATE has non null value and CLAIM-HEADER.DISCHARGE-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.DISCHARGE-DATE <= Valid Values End-Date) OR (CLAIM-HEADER.DISCHARGE-DATE has null value and CLAIM-HEADER.ADMISSION-DATE has non null value and CLAIM-HEADER.ADMISSION-DATE must be >= Valid Values Effective-Date and CLAIM-HEADER.ADMISSION-DATE <= Valid Values End-Date))