20217. EPMO Open Source Coordination Office Redaction File Detail Report

Produced by Araxis Merge on 6/20/2018 10:12:32 AM Central Daylight Time. See www.araxis.com for information about Merge. This report uses XHTML and CSS2, and is best viewed with a modern standards-compliant browser. For optimum results when printing this report, use landscape orientation and enable printing of background images and colours in your browser.

20217.1 Files compared

# Location File Last Modified
1 CCRS.zip\CCRS\CCRS-BUSRULES-v1.5.3.zip\CCRS-BUSRULES-v1.5.3-436e6fff1115001d614ccd45b469ad60a9bdb27b\docs\Rule_Specification\word_format referral_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 referral_rule_specification.docx Fri Jun 15 14:54:22 2018 UTC

20217.2 Comparison summary

Description Between
Files 1 and 2
Text Blocks Lines
Unchanged 1 66
Changed 0 0
Inserted 0 0
Removed 0 0

20217.3 Comparison options

Whitespace
Character case Differences in character case are significant
Line endings Differences in line endings (CR and LF characters) are ignored
CR/LF characters Not shown in the comparison detail

20217.4 Active regular expressions

No regular expressions were active.

20217.5 Comparison detail

  1   Referral R ules
  2   Descriptio n
  3   Automatica lly match  invoices t o existing  active re ferrals wi thin CCRS,  so only m atched inv oices are  processed.  Deny invo ices that  have no ma tching ref erral or i f the refe rral is no  longer ac tive, so t hat denial s can be s tored and  communicat ed. Approv e invoices  that do n ot include  referral  numbers if  the servi ce provide d was a fl u shot.
  4   Validation  Descripti on
  5   Valid Refe rral
  6   Any claim  that is no t a flu-sh ot must ha ve a valid  referral
  7   Date of Se rivce
  8   The Claim  line's ser vice date  must fall  within a r eferral's  valid date  range
  9   Logic
  10   Valid Refe rral & Dat e of Seriv ce - Appli es to INST -IO, PROF,  DENT:
  11   IF (the Cl aim.referr alNumber d oes NOT ma tch a Refe rral) THEN  {       F OREACH (Cl aimLine re lated to t he Claim)  {        I F (the Cla imLine.Pro cedure.Cod e does NOT  match 'G0 008' OR '9 0658' OR ' 90656' OR  '90662') T HEN {             cre ate Valida tionFailur e: validRe ferral, CA RC: 288, R ARC: N475  for Claim         }     }}            OTHER WISE {     FOREACH (C laimLine r elated to  the Claim)  {           IF (the  ClaimLine. serviceDat e is NOT ( before the  Referral. referralEx pirationDa te AND equ al OR afte r the Refe rral.refer ralDate))  THEN {              c reate Vali dationFail ure: refer ralDateOfS ervice, CA RC: 165, R ARC: N335  for ClaimL ine          }    }        }
  12   Notes
  13   Data Eleme nts:
  14   BRENGINE
  15   CCRSDB
  16   Claim.refe rralNumber
  17   DIM_VA_CLA IM.referra l_number
  18   Claim.prof ClaimLines **
  19   F_PROFESSI ONAL_MEDIC AL_CLAIM_D ETAILS
  20   ClaimLine. serviceDat e
  21   F_*_CLAIM_ DETAILS.se rvice_date
  22   Claim.clai mLines**
  23   F_*_CLAIM_ DETAILS
  24   ProfClaimL ine.isFluS hot**
  25   F_PROFESSI ONAL_MEDIC AL_CLAIM_D ETAILS
  26   ProfClaimL ine.Proced ure.code
  27   DIM_PROCED URE_CODE.p rocedure_c ode
  28   BRENGINE
  29   CCRSDB
  30   Referral.r eferralExp irationDat e
  31   ccra.REFER RAL.Referr alExpirati onDate
  32   Referral.r eferralDat e
  33   ccra.REFER RAL.Referr alDate