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Tier | 1.1 |
---|---|
Tier Description | Missing Value Error |
Error Category | E1105 |
Error Category Message | Data Element Value is Missing |
Rule Type | One Record Type (Single Record) |
File Segment Number | CRX00002 |
Data Element Name | CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE |
Validation Logic | 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', then CLAIM-HEADER-RECORD-RX has a non-null and not invalidly formatted value for PRESCRIPTION-FILL-DATE' |
Rule Definition | If a claim is a non-denied claim and is an original claim or a replacement/resubmission claim payment from an RX file, and is a Medicaid or Medicaid-expansion CHIP Fee for Service or Separate CHIP Fee for Service claim, then the claim header prescription fill date must be populated. |
Denominator Logic | # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-RX.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM does not equal 'Z' and with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS is not equal to one of the following: '26','026','87','087', '542','585', '654' and with CLAIM-HEADER-RECORD-RX.ADJUSTMENT-IND is equal to one of the following: '0', '4', and with TYPE-OF-CLAIM is equal to one of the following: '1', 'A' |