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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 | CRX00002 |
Data Element Name | CLAIM-LINE-RECORD-RX.DAYS-SUPPLY |
Validation Logic | 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR equals '0' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-LINE-RECORD-RX has a non-null value for DAYS-SUPPLY' |
Rule Definition | If a non-denied claim from an RX file has the type of claim Medicaid or Medicaid-expansion CHIP Managed Care Fee-for-service or Separate CHIP Fee-for-service, and is not a crossover claim, then the claim line days supply must be populated. |
Denominator Logic | # of RX claim lines with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and with CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to '0' and with CLAIM-HEADER-RECORD-RX.CROSSOVER-INDICATOR is equal to '0' and with CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' |