RULE-1630

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.ENDING-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.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.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135', '138', '139', '140', '141', '142', '143' and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE, then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE'
Rule Definition	If ending date of service is populated on a non-denied, non-void claim line from an OT file that is not a capitated payment, premium payment or EHR payment and adjudication date is populated on the claim line, then the ending date of service value reported must be before or equal to the adjudication date value reported.
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.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135', '138', '139', '140', '141', '142', '143' and with CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and with CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE

Published Date	Data Guide Version	Validation Rule	Action	Field	Before	After
08/21/2020	2.4.0	RULE-1630	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 ENDING-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.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE'
05/21/2021	3.0.0	RULE-1630	UPDATE	Data Dictionary - 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 ENDING-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.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE'	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 is not equal to '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.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 ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE'
08/26/2022	3.0.2	Rule-1630	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.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.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 ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE, then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE	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.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122', '135', '138’, '139’, '140’, '141’, '142’, '143’ and CLAIM-LINE-RECORD-OT has a valid, non-null value for ENDING-DATE-OF-SERVICE and CLAIM-LINE-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE, then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE
06/08/2018	2.3.0	RULE-1630	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 ENDING-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.ENDING-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 ENDING-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.ENDING-DATE-OF-SERVICE is less than or equal to CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE