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# | Location | File | Last Modified |
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1 | CCRS.zip\CCRS\CCRS-BUSRULES-v1.5.3.zip\CCRS-BUSRULES-v1.5.3-436e6fff1115001d614ccd45b469ad60a9bdb27b\docs\Rule_Specification\word_format | payment_authority_rule_specification.docx | Tue Apr 10 06:18:41 2018 UTC |
2 | CCRS.zip\CCRS\CCRS-BUSRULES-v1.5.3.zip\CCRS-BUSRULES-v1.5.3-436e6fff1115001d614ccd45b469ad60a9bdb27b\docs\Rule_Specification\word_format | payment_authority_rule_specification.docx | Fri Jun 15 14:52:30 2018 UTC |
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1 | PaymentAut hority Rul es | |
2 | Automatica lly evalua te line it ems on the invoice t o ensure t he payment authority in the 83 7COB has a matching obligation number in the Payme ntAuthorit yObligatio n Table. | |
3 | Logic | |
4 | PAYMENT_AU THORITY_WI TH_FLU_SHO T - Applie s to INST- IO, DENT: | |
5 | IF the Cla im.referra lNumber do es NOT mat ch a Refer ral THE N FOREACH ClaimLine related to the Claim IF ClaimLine .Procedure .code does NOT match 'G0008' O R '90658' OR '90656' OR '90662 ' THEN cr eate Valid ationFailu re with CA RC: RARC: for ClaimL ine OTHERWISE IF ClaimL ine.servic eDate is N OT within CptObligat ion.startD ate AND Cp tObligatio n.endDate THEN crea te Validat ionFailure with CARC : RARC: fo r ClaimLin eOTHERWISE IF Referr al.payment AuthorityO bligationI d does not exist THEN creat e Validati onFailure with CARC: RARC: for ClaimOTHE RWISE FORE ACH ClaimL ine relate d to the C laim IF ClaimLine .serviceDa te is NOT within Pay mentAuthor ityObligat ion.startD ate AND Pa ymentAutho rityObliga tion.endDa te THEN creat e Validati onFailure with CARC: RARC: for ClaimLine | |
6 | PAYMENT_AU THORITY_WI TH_FLU_SHO T - Applie s to PROF: | |
7 | IF the Cla im.referra lNumber do es NOT mat ch a Refer ral THE N FOREACH Profession alClaimLin e related to the Cla im IF Profess ionalClaim Line.Proce dure.code does NOT m atch 'G000 8' OR '906 58' OR '90 656' OR '9 0662' THE N create V alidationF ailure wit h CARC: RA RC: for Pr ofessional ClaimLine OTH ERWISE IF Profession alClaimLin e.serviceD ateTo is N OT within CptObligat ion.startD ate AND Cp tObligatio n.endDate THEN crea te Validat ionFailure with CARC : RARC: fo r Professi onalClaimL ineOTHERWI SE IF Refe rral.payme ntAuthorit yObligatio nId does n ot exist THEN cre ate Valida tionFailur e with CAR C: RARC: f or ClaimOT HERWISE FO REACH Prof essionalCl aimLine re lated to t he Claim IF Profe ssionalCla imLine.ser viceDateTo is NOT wi thin Payme ntAuthorit yObligatio n.startDat e AND Paym entAuthori tyObligati on.endDate TH EN create Validation Failure wi th CARC: R ARC: for P rofessiona lClaimLine | |
8 | Data Eleme nts | |
9 | BRENGINE | |
10 | CCRSDB | |
11 | Claim.clai mLines** | |
12 | F_*_CLAIM_ DETAILS | |
13 | Claim.refe rralNumber | |
14 | DIM_VA_CLA IM.referra l_number | |
15 | ClaimLine. isFluShot* * | |
16 | F_*_CLAIM_ DETAILS | |
17 | ClaimLine. serviceDat e | |
18 | F_*_CLAIM_ DETAILS.se rvice_date | |
19 | Profession alClaimLin e.procedur e.id | |
20 | DIM_PROCED URE_CODE.p rocedure_k ey | |
21 | Profession alClaimLin e.serviceD ateTo | |
22 | F_PROFESSI ONAL_MEDIC AL_CLAIM_D ETAILS.ser vice_date_ to | |
23 | BRENGINE | |
24 | CCRSDB | |
25 | Referral.p aymentAuth orityOblig ationId | |
26 | ccra.REFER RAL.Paymen tAuthority Obligation Id | |
27 | CptObligat ion.startD ate | |
28 | ccra.CPT_O BLIGATION. start_date | |
29 | CptObligat ion.endDat e | |
30 | ccra.CPT_O BLIGATION. end_date | |
31 | PaymentAut horityObli gation.sta rtDate | |
32 | ccra.PAYME NT_AUTHORI TY_OBLIGAT ION.start_ date | |
33 | PaymentAut horityObli gation.end Date | |
34 | ccra.PAYME NT_AUTHORI TY_OBLIGAT ION.end_da te |
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