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Tier | 3.0 |
---|---|
Tier Description | Relational error |
Error Category | E3002 |
Error Category Message | Values inconsistently specified (multiple record types, multi file) |
Rule Type | Three Record Type Rule |
File Segment Number | COT00003 |
Data Element Name | ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE |
Validation Logic | 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT has a non-null value for MSIS-IDENTIFICATION-NUM and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '139', '140', '141', '142' and CLAIM-HEADER-RECORD-OT has a non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-OT has a non-null value for ENDING-DATE-OF-SERVICE and ELIGIBILITY-DETERMINANTS has a non-null value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null value for ELIGIBILITY-DETERMINANT-END-DATE and (CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE >= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE), then ELIGIBILITY-DETERMINANTS has a non-null value for DUAL-ELIGIBLE-CODE and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE does not equal '00'' |
Rule Definition | #N/A |
Denominator Logic | # of OT claim headers with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR not equal to '0' AND with CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not equal to 'Z' AND with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS not in ('26','026','87','087','542','585', '654', '686') AND with CLAIM-HEADER-RECORD-OT.MSIS-IDENTIFICATION-NUM having a non-null value AND with CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS not in ('26','87','542','585', '654') AND with CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE in: '139', '140', '141', '142' AND with the CLAIM-HEADER-RECORD-ID.BEGINNING-DATE-OF-SERVICE having a non-null value AND with the CLAIM-HEADER-RECORD-ID.ENDING-DATE-OF-SERVICE having a non-null value AND with the ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE having a non-null value AND with the ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE having a non-null value AND with the range of CLAIM-HEADER-RECORD-ID.BEGINNING-DATE-OF-SERVICE and CLAIM-HEADER-RECORD-ID.ENDING-DATE-OF-SERVICE inside the range of ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE |