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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 | CLT00002 |
Data Element Name | CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT |
Validation Logic | 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-ALLOWED-AMT, then CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT is equal to the sum of all CLAIM-LINE-RECORD-LT.ALLOWED-AMT values' |
Rule Definition | If the total allowed amount is populated on a non-denied claim from an LT file, then the total allowed amount must equal the sum of all line-level allowed amounts. |
Denominator Logic | # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-LT.PAYMENT-LEVEL-IND equal to '2' AND with CLAIM-HEADER-RECORD-LT.TOT-ALLOWED-AMT valid, non-null |