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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 | CIP00002 |
Data Element Name | CLAIM-HEADER-RECORD-IP.MEDICAID-AMOUNT-PAID-DSH |
Validation Logic | 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X', then CLAIM-HEADER-RECORD-IP has a null value for MEDICAID-AMOUNT-PAID-DSH or CLAIM-HEADER-RECORD-IP.MEDICAID-AMOUNT-PAID-DSH equals '0.00'' |
Rule Definition | If a claim is a non-denied, Medicaid/Medicaid expansion CHIP, Separate CHIP or other service tracking claim from an IP file, then the claim header has a MEDICAID-AMOUNT-PAID-DSH value that is null or equal to '0.00' |
Denominator Logic | # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and with CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X' |