RULE-7217

Tier	1.1
Tier Description	Missing Value Error
Error Category	E1105
Error Category Message	Data Element Value is Missing
Rule Type	Two Record Type (1 to 1)
File Segment Number	COT00002
Data Element Name	CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE
Validation Logic	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
Rule Definition	If a claim is a non-denied claim and is an original claim or a replacement/resubmission claim payment from an OT file, and is a Medicaid or Medicaid-expansion CHIP FFS, Medicaid or Medicaid-expansion CHIP Encounter, separate CHIP FFS or separate CHIP Encounter claim or CHIP capitated or separate CHIP capitated payment, then the claim line beginning date of service must be populated.
Denominator Logic	# of OT claim lines with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and with CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and with CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4' and with CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', '2', 'B'

Published Date	Data Guide Version	Validation Rule	Action	Field	Before	After
08/21/2020	2.4.0	RULE-7217	UPDATE	Data Dictionary - Validation Rules	Rule only triggered on adjustment claim lines, not on original claims.	Rules will also be triggered on original claim lines and ADJUSTMENT-IND and LINE-ADJUSTMENT-IND will be used to join claim headers and claim lines for the purpose of applying line-level validation rules. 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', '3', 'A', 'C', '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
08/16/2019	2.3.0	RULE-7217	ADD	Data Dictionary - Validation Rules	N/A	'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1', then CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE'
04/17/2020	2.4.0	RULE-7217	UPDATE	Data Dictionary - Validation Rules	IF (CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2'AND CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal to '0'AND CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM NOT IN ('Z')AND CLAIM-HEADER-RECORD-OT.CLAIM-STATUS NOT IN ("26","026","87","087","542","585", "654", "686")AND CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS NOT IN ("26","026","87","087","542","585", "654", "686")AND CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1'THEN CLAIM-LINE-OT.BEGINNING-DATE-OF-SERVICE must have a valid non-null value	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C","2","B"), then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'
06/19/2020	2.4.0	RULE-7217	UPDATE	Data Dictionary - Validation Rules	One Record Type(Single Record)	Two Record Type (1 to 1)
09/03/2021	3.0.0	RuLE-7217	UPDATE	Data Dictionary - Validation Rules	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND does not equal '1' and TYPE-OF-CLAIM in ("1","3","A","C","2","B"), then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'	if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: 'Z' and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '4', and TYPE-OF-CLAIM is equal to one of the following: '1','3','A','C', '2', 'B', then CLAIM-LINE-RECORD-OT has a non-null and not invalidly formatted value for BEGINNING-DATE-OF-SERVICE'