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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-LINE-RECORD-OT.LINE-ADJUSTMENT-IND |
Validation Logic | 'if CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and CLAIM-LINE-RECORD-OT has a non-null value for LINE-ADJUSTMENT-IND, then If the field is populated, the value must be contained in the set of valid values with id: 'LINE-ADJUSTMENT-IND' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)' |
Rule Definition | If the type of claim is a fee-for-service and line adjustment indicator is populated on a claim line from an OT file, then the line adjustment indicator value reported must be in the list of valid values for line adjustment indicator. |
Denominator Logic | # of OT claim lines with CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A' and with CLAIM-LINE-RECORD-OT.LINE-ADJUSTMENT-IND equal to a non-null value |