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Tier | 3.0 |
---|---|
Tier Description | Relational error |
Error Category | E3002 |
Error Category Message | Values inconsistently specified (multiple record types, multi file) |
Rule Type | Three Record Type Rule |
File Segment Number | ELG00002 |
Data Element Name | CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE |
Validation Logic | 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'M', then CLAIM-LINE-RECORD-IP.TYPE-OF-SERVICE does not equal '086'' |
Rule Definition | If a non-denied IP claim and a primary demographics eligibility segment has a value populated for sex that equals 'male' then the RX claim line must not have a type of service populated that equals other pregnancy-related procedures. |
Denominator Logic | # of IP claim lines with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' and with PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equal to 'M' |