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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 | CRX00003 |
Data Element Name | CLAIM-HEADER-RECORD-RX.SUBMITTING-STATE • CLAIM-HEADER-RECORD-RX.ICN-ORIG • CLAIM-HEADER-RECORD-RX.ICN-ADJ • CLAIM-HEADER-RECORD-RX.ADJUDICATION-DATE • CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND |
Validation Logic | if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY equals 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR equals '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM equals 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is equal to one of the following: '26', '87', '542', '585', '654', then for every record of type CLAIM-HEADER-RECORD-RX, there must be a valid record of type CLAIM-LINE-RECORD-RX that matches on the join keys(CLAIM-LINE-RECORD-RXnull, CLAIM-HEADER-RECORD-RXnull) |
Rule Definition | All denied RX claim header records must have a corresponding claim line record. |
Denominator Logic | # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY equals 'F2' and with CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR equals '0' and with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM equals 'Z' and with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is equal to one of the following: '26', '87', '542', '585', '654' |