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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 | Four Record Type Rule |
File Segment Number | CIP00002 |
Data Element Name | CLAIM-LINE-RECORD-IP.SUBMITTING-STATE • CLAIM-LINE-RECORD-IP.SERVICING-PROV-NUM |
Validation Logic | if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NUM, then for every record of type CLAIM-LINE-RECORD-IP, (there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '1' and (CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE >= PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE)) OR (there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys and (CLAIM-LINE-RECORD-IP.BEGINNING-DATE-OF-SERVICE >= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE)) |
Rule Definition | If the servicing provider number is populated on a non-denied claim from the IP file, then either the servicing provider number value reported must be equal to a provider identifier value reported with a provider identifier type value for state-assigned Medicaid provider identifiers on a provider identifiers segment from a PRV file where the effective and end dates of the provider identifiers segment overlap with the beginning date of service and (if populated) ending date of service on the claim line OR the servicing provider number value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the beginning date of service and (if populated) ending date of service on the claim line. |
Denominator Logic | # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and with CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and with CLAIM-LINE-RECORD-IP has a valid, non-null value for SERVICING-PROV-NUM |