RULE-7354

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Tier	2.1
Tier Description	Relational error
Error Category	E2102
Error Category Message	Values inconsistently specified (multi record, single file)
Rule Type	Two Record Type (1 to 1)
File Segment Number	COT00002
Data Element Name	CLAIM-LINE-RECORD-OT.REVENUE-CODE • CLAIM-LINE-RECORD-OT.PROCEDURE-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' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE or CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE'
Rule Definition	If a non-denied claim line from an OT file has the type of claim equal to '1','3','A','C', then the procedure code must be populated, or the claim revenue code must be populated.
Denominator Logic	# of OT claim lines with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and with CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and with TYPE-OF-CLAIM is equal to the following: '1', '3', 'A', 'C'

Published Date	Data Guide Version	Validation Rule	Action	Field	Before	After
09/11/2020	2.4.0	Rule-7354	ADD	Data Dictionary - Validation Rules	N/A	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' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and TYPE-OF-CLAIM is equal to the following: '1', '3', 'A', 'C' then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE and CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE'
11/13/2020	2.4.0	Rule-7354	UPDATE	Data Dictionary - Validation Rules	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' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE and CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE'	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' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following:'26', '026', '87', '087', '542', '585', '654' and TYPE-OF-CLAIM is equal to the following: '1', '3', 'A', 'C' then CLAIM-LINE-RECORD-OT has a non-null value for PROCEDURE-CODE or CLAIM-LINE-RECORD-OT has a non-null value for REVENUE-CODE'