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Tier | 1.1 |
---|---|
Tier Description | Value Error |
Error Category | E1103 |
Error Category Message | Value not in specified valid value set |
Rule Type | Valid Value |
File Segment Number | CIP00002 |
Data Element Name | CLAIM-LINE-RECORD-IP.MBESCBES-FORM |
Validation Logic | 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and the MBESCBES-FORM field is populated and CLAIM-LINE-RECORD-IP.MBESCBES-FORM-GROUP equals '3', then If the MBESCBES-FORM field is populated, the value must be contained in the set of valid values with id: 'MBESCBES-FORMGP-3' and (if CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-IP.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
Rule Definition | If the MBESCBES form is populated and MBESCBES form group is '3' on a non-denied claim line from a IP file, then the MBESCBES form reported must be found in the list of valid values for 'MBESCBES-3'. |
Denominator Logic | # of IP claim lines with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and with CLAIM-LINE-RECORD-IP.MBESCBES-FORM equal to a valid, non-null value and with CLAIM-LINE-RECORD-IP.MBESCBES-FORM-GROUP is equal to '3' |