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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 | COT00002 |
Data Element Name | CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE |
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.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', then CLAIM-HEADER-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE' |
Rule Definition | If a claim is a non-denied, non-void claim from an OT file, and is a Medicaid/Medicaid-expansion CHIP or S-CHIP service tracking claim and is an original claim or a replacement/resubmission claim payment then the claim header beginning date of service must be populated. |
Denominator Logic | # of OT claim headers CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D' |