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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 | Two Record Type (1 to 1) |
File Segment Number | COT00002 |
Data Element Name | CLAIM-LINE-RECORD-OT.PROCEDURE-CODE • CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG |
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.ADJUSTMENT-IND does not equal '1' 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', '87', '542', '585', '654', '686' and CLAIM-LINE-RECORD-OT has a valid, non-null value for PROCEDURE-CODE, then CLAIM-LINE-RECORD-OT.PROCEDURE-CODE is a valid value specified by CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG or is a state valid value from 'PROCEDURE-CODE-STATE'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '01', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'CPT'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '02', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'ICD-9-PROCEDURE-CODE'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '06', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'HCPCS'. when CLAIM-LINE-RECORD-OT.PROCEDURE-CODE-FLAG is '07', CLAIM-LINE-RECORD-OT.PROCEDURE-CODE should be a valid value in 'ICD-10-PROCEDURE-CODE'.' |
Rule Definition | If the procedure code is populated on a non-denied, non-void claim line from an OT file, then the procedure code must be a valid value from the list of procedure code values corresponding to the procedure code flag. |
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.ADJUSTMENT-IND is not equal to '1' and with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', '686' and with CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', '686' and with CLAIM-LINE-RECORD-OT has a valid, non-null value for PROCEDURE-CODE |