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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 | CIP00002 |
Data Element Name | CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT |
Validation Logic | 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT is greater than or equal to the sum of all CLAIM-LINE-RECORD-IP.REVENUE-CHARGE values' |
Rule Definition | If the total billed amount is populated on a non-denied claim from an IP file, then the total billed amount must be greater than or equal the sum of all line-level revenue charge amounts. |
Denominator Logic | # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-IP.PAYMENT-LEVEL-IND equal to '2' AND with CLAIM-HEADER-RECORD-IP.TOT-BILLED-AMT valid, non-null |