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Tier | 1.1 |
---|---|
Tier Description | Missing Value Error |
Error Category | E1105 |
Error Category Message | Data Element Value is Missing |
Rule Type | Two Record Type (1 to 1) |
File Segment Number | CLT00002 |
Data Element Name | CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE |
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-LINE-RECORD-LT.CLAIM-LINE-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.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for ENDING-DATE-OF-SERVICE' |
Rule Definition | If a claim is on a non-denied claim and is an original claim or a replacement/resubmission claim payment from an LT file, and is a Medicaid or Medicaid-expansion CHIP Fee for Service or Separate CHIP Fee for Service claim, then the claim line ending date of service must be populated. |
Denominator Logic | # of LT claim lines 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-LINE-RECORD-LT.CLAIM-LINE-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 one of the following: '0', '4', and with TYPE-OF-CLAIM is equal to one of the following: '1', 'A' |