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Tier | 1.1 |
---|---|
Tier Description | Missing Value Error |
Error Category | E1105 |
Error Category Message | Data Element Value is Missing |
Rule Type | One Record Type (Single Record) |
File Segment Number | CIP00002 |
Data Element Name | CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE |
Validation Logic | 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-IP.PATIENT-STATUS does not equal '30' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', then CLAIM-HEADER-RECORD-IP has a non-null and not invalidly formatted value for DISCHARGE-DATE' |
Rule Definition | If a claim is a non-denied claim and is an original claim or a replacement/resubmission claim payment from an IP file, and is a Medicaid or Medicaid-expansion CHIP FFS, Medicaid or Medicaid-expansion CHIP Encounter, separate CHIP FFS or separate CHIP Encounter claim, and the patient is not still a patient, then the discharge date must be populated. |
Denominator Logic | # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and with CLAIM-HEADER-RECORD-IP.ADJUSTMENT-IND is equal to one of the following: '0', '4' and with CLAIM-HEADER-RECORD-IP.PATIENT-STATUS does not equal '30' and with CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C' |