Official websites use .gov
A
.gov website belongs to an official government
organization in the United States.
Secure .gov websites use HTTPS
A
lock () or https:// means you've safely connected to
the .gov website. Share sensitive information only on official,
secure websites.
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 | COT00002 |
Data Element Name | CLAIM-HEADER-RECORD-OT.MEDICAID-PAID-DATE • CLAIM-LINE-RECORD-OT.XIX-MBESCBES-CATEGORY-OF-SERVICE • CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE |
Validation Logic | 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the field is populated, the value must be contained in the set of valid values with id: 'XIX-MBESCBES-CATEGORY-OF-SERVICE' and ((if CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE is non-null then CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ADJUDICATION-DATE <= Valid Values End-Date) OR (if CLAIM-HEADER-RECORD-OT.MEDICAID-PAID-DATE is non-null then CLAIM-HEADER-RECORD-OT.MEDICAID-PAID-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.MEDICAID-PAID-DATE <= Valid Values End-Date))' |
Rule Definition | If the XIX MBESCBES category of service is populated on a non-denied claim line from an OT file, then the XIX MBESCBES category of service value reported must be in the list of valid values for XIX MBESCBES category of service. |
Denominator Logic | # of OT claim lines with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' and with CLAIM-LINE-RECORD-OT.XIX-MBESCBES-CATEGORY-OF-SERVICE equal to a valid, non-null value |