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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 | COT00002 |
Data Element Name | CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT • CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT • CLAIM-LINE-RECORD-OT.MEDICARE-PAID-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.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR equals '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then (CLAIM-LINE-RECORD-OT has a non-null value for MEDICARE-PAID-AMT and CLAIM-LINE-RECORD-OT.MEDICARE-PAID-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-COINS-AMT does not equal '0.00') or (CLAIM-HEADER-RECORD-OT has a non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT and CLAIM-HEADER-RECORD-OT.TOT-MEDICARE-DEDUCTIBLE-AMT does not equal '0.00')' |
Rule Definition | If a claim is a non-denied, crossover Medicaid or M-CHIP or Separate CHIP Fee-for-Service, original or adjustment paid claim from an OT file, then the claim must have a non-null value and not zero value for medicare paid amount or total medicare coinsurance amount or total medicare deductible amount. |
Denominator Logic | # of OT claim lines 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.TYPE-OF-CLAIM does not equal 'Z' 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-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and with CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and with CLAIM-HEADER-RECORD-OT.CROSSOVER-INDICATOR is equal to '1' and with CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' |