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.
No Updates
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 | CIP00002 |
Data Element Name | CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-11 • CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-FLAG-11 |
Validation Logic | 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for DIAGNOSIS-CODE-11, then when CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-FLAG-11 is '1', CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-11 should be a valid value in 'ICD-9-DIAGNOSIS-CODE'. when CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-FLAG-11 is '2', CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-11 should be a valid value in 'ICD-10-DIAGNOSIS-CODE'.' |
Rule Definition | If the eleventh diagnosis code is populated and the eleventh diagnosis code flag is for ICD-9 or ICD-10 codes on a non-denied claim from an IP file, then the value for the eleventh diagnosis code must be a valid value from the list of values for ICD-9 or ICD-10 codes, respectively. |
Denominator Logic | # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-11 equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-IP.DIAGNOSIS-CODE-FLAG-11 in: '1', '2' |