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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 | CLT00002 |
Data Element Name | CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT • CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT • CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT |
Validation Logic | 'if 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' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then (CLAIM-HEADER-RECORD-LT has a null value for MEDICARE-PAID-AMT or CLAIM-HEADER-RECORD-LT.MEDICARE-PAID-AMT equals '0.00') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-COINS-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT equals '0.00') and (CLAIM-HEADER-RECORD-LT has a null value for TOT-MEDICARE-DEDUCTIBLE-AMT or CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT equals '0.00')' |
Rule Definition | If a claim is a non-denied, non-crossover Medicaid Encounter, original or adjustment paid claim from an LT file, then the claim must have a null value or zero value for medicare paid amount, total medicare coinsurance amount and total medicare deductible amount. |
Denominator Logic | # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and with CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND is equal to '0' or '4' and with CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0' and with CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' |