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Tier | 1.1 |
---|---|
Tier Description | Value Error |
Error Category | E1103 |
Error Category Message | Value not in specified valid value set |
Rule Type | Valid Value |
File Segment Number | CRX00002 |
Data Element Name | CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND |
Validation Logic | 'if CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C', then If the ADJUSTMENT-IND field is populated, the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)' |
Rule Definition | If the type of claim is an encounter and adjustment indicator is populated on a claim header from an RX file, then the adjustment indicator value reported must be in the list of valid values for adjustment indicator. |
Denominator Logic | # of RX claim headers with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '3', 'C' and with CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equal to a valid, non-null value |