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Tier | 2.0 |
---|---|
Tier Description | Relational error |
Error Category | E2001 |
Error Category Message | Values inconsistently specified (single record type, single record) |
Rule Type | One Record Type (Single Record) |
File Segment Number | COT00002 |
Data Element Name | CLAIM-HEADER-RECORD-OT.SERVICE-TRACKING-PAYMENT-AMT |
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.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 not equal to one of the following: '4', 'D', 'X', 'Z', then CLAIM-HEADER-RECORD-OT has a null value for SERVICE-TRACKING-PAYMENT-AMT or CLAIM-HEADER-RECORD-OT.SERVICE-TRACKING-PAYMENT-AMT equals '0.00'' |
Rule Definition | If a claim is a non-denied, non-service tracking claim from an OT file, then the service tracking payment amount is not populated or equal to '0.00'. |
Denominator Logic | # of OT claim headers 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.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and with CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '4', 'D', 'X', 'Z' |