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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.TOT-TPL-AMT • CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT • CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT • CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT |
Validation Logic | 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-TPL-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-COINS-AMT and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-MEDICARE-DEDUCTIBLE-AMT, then the absolute value of CLAIM-HEADER-RECORD-LT.TOT-TPL-AMT is less than or equal to the absolute value of (CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT - (CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT + CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT))' |
Rule Definition | If the total TPL amount, total billed amount, Medicare coinsurance amount, and Medicare deductible amount are populated on a non-denied claim from an LT file, then the absolute value of the total TPL amount is less than or equal to the absolute value of (total billed amount - (Medicare coinsurance amount + Medicare deductible 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.TOT-TPL-AMT equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-COINS-AMT equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-LT.TOT-MEDICARE-DEDUCTIBLE-AMT equal to a valid, non-null value |