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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 | CIP00002 |
Data Element Name | CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT |
Validation Logic | 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY equals 'F2' or CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR equals '0' or CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM equals 'Z' or CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-IP has a null value for TOT-MEDICAID-PAID-AMT or CLAIM-HEADER-RECORD-IP.TOT-MEDICAID-PAID-AMT equals '0.00'' |
Rule Definition | If an IP claim header is for a denied claim, then total medicaid paid amount has a missing or zero value. |
Denominator Logic | # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY equals 'F2' or with CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR equals '0' or with CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM equals 'Z' or with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |