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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.MEDICARE-COMB-DED-IND |
Validation Logic | 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0', then CLAIM-HEADER-RECORD-LT.MEDICARE-COMB-DED-IND equals '0'' |
Rule Definition | If a claim is a non-denied, non-crossover LT claim that is an encounter claim, then the medicare comb ded indicator must be an amount not combined with the coinsurance amount. |
Denominator Logic | # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-LT.CROSSOVER-INDICATOR equals '0' AND with CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to: '3', 'C', 'W' |