20218. EPMO Open Source Coordination Office Redaction File Detail Report

Produced by Araxis Merge on 6/20/2018 10:12:33 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.

20218.1 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 timely_filing_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 timely_filing_rule_specification.docx Fri Jun 15 14:54:41 2018 UTC

20218.2 Comparison summary

Description Between
Files 1 and 2
Text Blocks Lines
Unchanged 1 98
Changed 0 0
Inserted 0 0
Removed 0 0

20218.3 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

20218.4 Active regular expressions

No regular expressions were active.

20218.5 Comparison detail

  1   TimelyFili ng Rules
  2   Descriptio n
  3   Verify the  invoice c laim is re ceived wit hin the ti mely filin g period,  so that th e claim is  accepted  if the dat e of servi ce is with in the pre -defined p eriod of t ime and de nied if it  is not wi thin the p re-defined  period of  time.
  4   Validation  Descripti on
  5   Timely Sub mission
  6   Claims mus t be submi tted withi n 180 days  of the cl aim date o f service
  7   Timely Pro vider Paym ent
  8   Claims mus t be paid  within 30  days of re ceiving th e claim
  9   Timely Res ubmission
  10   Rejected C laim Lines  must be r esubmitted  within 30  days of r ejection d ate
  11   Validation  Logic
  12   Timely Sub mission -  Applies to  INST-IO:
  13   IF (the Cl aim.receiv edDate is  180 days G REATER tha n the Clai m.instClai m.admissio nDate) THE N {        create Val idationFai lure: time lySubmissi on, CARC:  226 RARC:  N385 for C laim}
  14   Timely Sub mission -  Applies to  PROF, DEN T:
  15   FOREACH Cl aimLine re lated to t he Claim {     IF (th e Claim.re ceivedDate  is 180 da ys GREATER  than the  ClaimLine. serviceDat e) THEN {          cr eate Valid ationFailu re: timely Submission , CARC: 22 6 RARC: N3 85 for Cla imLine      }}
  16   Timely Pro vider Paym ent Applie s to INST- IO, PROF,  DENT:
  17   FOREACH Cl aimLine re lated to t he Claim {     IF (th e Claim.re ceivedDate  is 30 day s GREATER  than the C laimLine.d ateProvide rPaid) THE N {           create  Validation Failure: t imelyProvi derPayment , CARC: 22 6 RARC: N3 85 for Cla imLine     }       }
  18   Timely Res ubmission  Applies to  INST-IO,  PROF, DENT :
  19   IF (the Cl aim is a R esubmissio n) THEN {       fetch  the origi nal Claim       FOREA CH ClaimLi ne related  to the Re submission Claim {           IF  (the Resub missionCla imLine.lin eItemContr olNumber d oes NOT ma tch any Or iginalClai mLine.line ItemContro lNumber) T HEN {               c reate Vali dationFail ure: timel yResubmiss ion, CARC:  226 RARC:  N385 for  Resubmissi onClaimLin e        }         OT HERWISE IF  (the Resu bmissionCl aim.receiv eDate is 3 0 days GRE ATER than  OriginalCl aim.decisi on.decisio nDate) THE N {              crea te Validat ionFailure : timelyRe submission , CARC: 22 6 RARC: N3 85 for Res ubmissionC laimLine         }     }}
  20   Notes
  21   Data Eleme nts
  22   BRENGINE
  23   CCRSDB
  24   Claim.rece ivedDate
  25   DIM_VA_CLA IM.receive d_date
  26   Claim.inst Claim.admi ssionDate
  27   DIM_INSTIT UTIONAL_CL AIM.admiss ion_date
  28   Claim.sour ceSystem
  29   DIM_VA_CLA IM.source_ system
  30   Claim.clai mId
  31   DIM_VA_CLA IM.claim_i d
  32   Claim.deci sions**
  33   DECISION
  34   Claim.clai mLines**
  35   F_*_CLAIM_ DETAILS
  36   ClaimLine. key
  37   F_*_CLAIM_ DETAILS.cl aim_detail _key
  38   ClaimLine. lineItemCo ntrolNumbe r
  39   F_*_CLAIM_ DETAILS.li ne_item_co ntrol_numb er
  40   ClaimLine. serviceDat e
  41   F_*_CLAIM_ DETAILS.se rvice_date
  42   ClaimLine. dateProvid erPaid
  43   F_*_CLAIM_ DETAILS.da te_paid
  44   Decision.c laimLineKe y
  45   DECISION.c laim_detai l_key
  46   Decision.d escisionTy pe
  47   DECISION.d ecision
  48   Decision.d ecisionDat e
  49   DECISION.d ecision_da te_time