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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 Many) |
File Segment Number | CLT00002 |
Data Element Name | CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS • CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-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.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-LT.PAYMENT-LEVEL-IND equals '2', then CLAIM-HEADER-RECORD-LT.TOT-MEDICAID-PAID-AMT is equal to the sum of all CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT values, where CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'' |
Rule Definition | If a claim is a non-denied claim from an LT file that is an original claim and is a Medicaid or Medicaid-expansion CHIP or Separate CHIP Fee-for-Service claim, and the payment level indicator is for line, then the sum of the claim line medicaid paid amount is equal to the claim header total medicaid paid 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.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and with CLAIM-HEADER-RECORD-LT.ADJUSTMENT-IND equals '0' and with CLAIM-HEADER-RECORD-LT.PAYMENT-LEVEL-IND equals '2' |