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Tier | 2.0 |
---|---|
Tier Description | Relational error |
Error Category | E2001 |
Error Category Message | Values inconsistently specified (single record type, single record) |
Rule Type | One Record Type (Single Record) |
File Segment Number | CLT00002 |
Data Element Name | CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-5 • CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-FLAG-5 |
Validation Logic | 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for DIAGNOSIS-CODE-5, then when CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-FLAG-5 is '1', CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-5 should be a valid value in 'ICD-9-DIAGNOSIS-CODE'. when CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-FLAG-5 is '2', CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-5 should be a valid value in 'ICD-10-DIAGNOSIS-CODE'.' |
Rule Definition | If the fifth diagnosis code is populated on a non-denied claim from an LT file, then the value for the fifth diagnosis code must be a valid value from the list of values for diagnosis codes corresponding to the fifth diagnosis code flag. |
Denominator Logic | # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-5 equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-LT.DIAGNOSIS-CODE-FLAG-5 in: '1', '2' |