RULE-1624

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Tier	2.1
Tier Description	Relational error
Error Category	E2102
Error Category Message	Values inconsistently specified (multi record, single file)
Rule Type	Two Record Type (1 to 1)
File Segment Number	COT00002
Data Element Name	CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE • CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE
Validation Logic	'if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE'
Rule Definition	If beginning date of service and adjudication date are populated on a non-denied claim line from an OT file that is not a capitated payment, premium payment, or EHR payment to provider, then the beginning date of service value reported must be before or equal to the adjudication date value reported.
Denominator Logic	# of OT claim lines with CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' AND with CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE not in: '119', '120', '121', '122', '135' AND with CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE equal to a valid, non-null value AND with CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2'

Published Date	Data Guide Version	Validation Rule	Action	Field	Before	After
08/21/2020	2.4.0	RULE-1624	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-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE'
06/08/2018	2.3.0	RULE-1624	UPDATE	Data Dictionary - Validation Rules	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS does not equal '585' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE	if CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135' and CLAIM-LINE-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE