20214. EPMO Open Source Coordination Office Redaction File Detail Report

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20214.1 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 duplicate_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 duplicate_rule_specification.docx Fri Jun 15 14:50:38 2018 UTC

20214.2 Comparison summary

Description Between
Files 1 and 2
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20214.3 Comparison options

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Character case Differences in character case are significant
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CR/LF characters Not shown in the comparison detail

20214.4 Active regular expressions

No regular expressions were active.

20214.5 Comparison detail

  1   DuplicateR ules
  2   Descriptio n
  3   Automatica lly identi fy the dup licate lin e item sub mitted wit hin the co ntracted r eimburseme nt invoice  using the  unique co mbination  of invoice  line data  so that i mproper pa yments can  be preven ted.
  4   Validation  Descripti on
  5   Duplicate  Profession al
  6   There must  not exist  two claim s with equ al values  for all of  the follo wing eleme nts:-Patie nt ID-Prov ider NPI-P rocedure C ode-Place  of Serivce -Service D ate From-B illed Amou nt-Procedu re Modifie rs
  7   Duplicate  Institutio nal Inpati ent
  8   There must  not exist  two claim s with equ al values  for all th e followin g elements :-Statemen t To Date- Statement  From Date- Patient ID -Provider  NPI
  9   Duplicate  Institutio nal Outpat ient
  10   There must  not exist  two claim s with equ al values  for all th e followin g elements :-Patient  ID-Provide r NPI-Proc edure Code -Service D ate-Billed  Amount-Pr ocedure Mo difiers
  11   Duplicate  Dental
  12   There must  not exist  two claim s with equ al values  for all th e followin g elements :-Patient  ID-Provide r NPI-Proc edure Code -Service D ate-Teeth  Serviced
  13   Logic
  14   Duplicate  Profession al - Appli es to PROF :
  15   FOREACH (P rofessiona lClaimLine  pcl relat ed to the  Claim) {     IF (ther e exists a nother Pro fessionalC laimLine w ith the fo llowing eq ual elemen ts to pcl         Pro fessionalC laimLine.c laim.patie nt.memberI d        P rofessiona lClaimLine .providerO fInterest. npi         Professio nalClaimLi ne.procedu re.code         Profe ssionalCla imLine.pla ceOfServic e.code         Profes sionalClai mLine.serv iceDateFro m          Profession alClaimLin e.chargeAm t        P rofessiona lClaimLine .modifiers ) THEN {         crea te Validat ionFailure : , CARC:  18, RARC:  18 for Pro fessionalC laimLine     }}
  16   Duplicate  Institutio nal Inpati ent - Appl ies to INS T-I:
  17   FOREACH (I nstitution alClaimLin e icl rela ted to the  Claim) {     IF (the re exists  another In stitutiona lClaimLine  with the  following  equal elem ents to ic l        I nstitution alClaimLin e.claim.in stClaim.st atementToD ate         Instituti onalClaimL ine.claim. instClaim. statementF romDate         Insti tutionalCl aimLine.cl aim.patien t.memberId         In stitutiona lClaimLine .providerO fInterest. npi) THEN  {        c reate Vali dationFail ure: , CAR C: 18, RAR C: 18 for  Institutio nalClaimLi ne    }}
  18   Duplicate  Institutio nal Outpat ient - App lies to IN ST-O:
  19   FOREACH (I nstitution alClaimLin e icl rela ted to the  Claim) {     IF (the re exists  another In stitutiona lClaimLine  with the  following  equal elem ents to ic l        I nstitution alClaimLin e.claim.pa tient.memb erId         Institut ionalClaim Line.provi derOfInter est.npi         Insti tutionalCl aimLine.pr ocedure.co de         Institutio nalClaimLi ne.service Date         Institut ionalClaim Line.charg eAmt         Institut ionalClaim Line.modif iers) THEN  {         create Val idationFai lure: , CA RC: 18, RA RC: 18 for  Instituti onalClaimL ine    }}
  20   Duplicate  Dental - A pplies to  DENT:
  21   FOREACH (D entalClaim Line dcl r elated to  the Claim)  {    IF ( there exis ts another  DentalCla imLine wit h the foll owing equa l elements  to dcl         Denta lClaimLine .claim.pat ient.membe rId         DentalCla imLine.pro viderOfInt erest.npi         Den talClaimLi ne.procedu re.code         Denta lClaimLine .serviceDa te         DentalClai mLine.clai m.dentClai mTeeth) TH EN {          create  Validation Failure: ,  CARC: 18,  RARC: 18  for Dental ClaimLine     }}
  22   Data Eleme nts
  23   BRENGINE
  24   CCRSDB
  25   Claim.prof ClaimLines **
  26   F_PROFESSI ONAL_MEDIC AL_CLAIM_D ETAILS
  27   Claim.sour ceSystem
  28   DIM_VA_CLA IM.source_ system
  29   Claim.pati ent.member Id
  30   DIM_PATIEN T.member_i d
  31   Claim.inst Claim**
  32   DIM_INSTIT UTIONAL_CL AIM
  33   Claim.inst ClaimLines **
  34   F_INSTITUT IONAL_MEDI CAL_CLAIM_ DETAILS
  35   Claim.dent ClaimLines
  36   F_DENTAL_C LAIM_DETAI LS
  37   Claim.dent ClaimTeeth **
  38   CLAIM_TOOT H_STATUS
  39   Profession alClaimLin e.placeOfS ervice
  40   DIM_PLACE_ OF_SERVICE
  41   Profession alClaimLin e.placeOfS ervice.cod e
  42   DIM_PLACE_ OF_SERVICE .pos_code
  43   Profession alClaimLin e.provider OfInterest .npi**
  44   DIM_PROVID ER.npi
  45   Profession alClaimLin e.procedur e.code
  46   DIM_PROCED URE_CODE.p rocedure_c ode
  47   Profession alClaimLin e.serviceD ateFrom
  48   F_PROFESSI ONAL_MEDIC AL_CLAIM_D ETAILS.ser vice_date_ from
  49   Profession alClaimLin e.chargeAm t
  50   F_PROFESSI ONAL_MEDIC AL_CLAIM_D ETAILS.cha rge_amount
  51   Profession alClaimLin e.modifier s**
  52   CLAIM_LINE _MODIFIER
  53   Profession alClaimLin e.serviceD ateTo
  54   F_PROFESSI ONAL_MEDIC AL_CLAIM_D ETAILS.ser vice_date_ to
  55   Institutio nalClaim.s tatementFr omDate
  56   DIM_INSTIT UTIONAL_CL AIM.statem ent_from_d ate
  57   Institutio nalClaim.s tatementTo Date
  58   DIM_INSTIT UTIONAL_CL AIM.statem ent_to_dat e
  59   Institutio nalClaimLi ne.provide rOfInteres t.npi**
  60   DIM_PROVID ER.npi
  61   Institutio nalClaimLi ne.procedu re.code
  62   DIM_PROCED URE_CODE.p rocedure_c ode
  63   Institutio nalClaimLi ne.service Date
  64   F_INSTITUT IONAL_MEDI CAL_CLAIM_ DETAILS.se rvice_date
  65   Institutio nalClaimLi ne.chargeA mt
  66   F_INSTITUT IONAL_MEDI CAL_CLAIM_ DETAILS.ch arge_amoun t
  67   DentalClai mLine.prov iderOfInte rest.npi**
  68   DIM_PROVID ER.npi
  69   DentalClai mLine.proc edure.code
  70   DIM_PROCED URE_CODE.p rocedure_c ode
  71   DentalClai mLine.serv iceDate
  72   F_DENTAL_C LAIM_DETAI LS.service _date
  73   DentalClai mLine.modi fiers**
  74   CLAIM_LINE _MODIFIER
  75   Modifier.c ode
  76   CLAIM_LINE _MODIFIER. modifier_c ode