09/11/2020
|
2.4.0 |
RULE-7375
|
ADD |
Data Dictionary - Validation Rules |
N/A |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to "0" or "4" and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
11/13/2020
|
2.4.0 |
Rule-7375
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
01/27/2021
|
3.0.0 |
RULE-7375
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
12/04/2020
|
2.4.0 |
RULE-7375
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to '1' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' or '4' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' or CLAIM-LINE-RECORD-RX has a non-null value for XXI-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is not equal to '1' and CLAIM-HEADER-RECORD-RX has a non-null, and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26','026','87','087','542','585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is equal to '01' then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE |
03/19/2021
|
3.0.0 |
RULE-7375
|
UPDATE |
Data Dictionary - Validation Rules |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |
if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', '5' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-RX has a null value and not invalidly formatted value for TOT-MEDICAID-PAID-AMT and CLAIM-HEADER-RECORD-RX.TOT-MEDICAID-PAID-AMT is not equal to 0.00 and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-RX.CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT equals '01', then CLAIM-LINE-RECORD-RX has a non-null value for XIX-MBESCBES-CATEGORY-OF-SERVICE' |