Audit_Dictionary by ngo10999

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									                                                            AS/ED AUDIT DICTIONARY
Audit
 #                                        Audit Message                                      Audit Description                               Audit     Severity
         HEADER     Transaction Code is not Q or S                  Must be a single alpha character (Q) or (S) only.                                Error
 12      HEADER     Report Year is not a valid format               Must be 4 digit numeric using valid year format (YYYY)                           Error
 13      HEADER     Report Quarter not between 1 and 4              Must be single numeric using (1,2,3 or 4) only                                   Error
 14      HEADER     Data Type is not AS10                           Must be alpha/numeric using (AS10) only                                          Error
 15      HEADER     Submission Type is not I,R, or C                Must be a single alpha character (I, R or C).                                    Error
                                                                    Must be numeric characters using a valid date and format (YYYY-MM-
 16      HEADER     Processing Date is invalid                                                                                                       Error
                                                                    DD)
                                                                    Must be at least 8 but no more than 10 numeric characters using a
 17      HEADER     Facility Name is empty                                                                                                           Error
                                                                    valid facility ID number assigned by AHCA.
                                                                    Must be no more than 25 alpha characters. Last name, First name
 18      HEADER     Contact Name is empty                                                                                                            Error
                                                                    format.
                                                                    Must contain at least 10 numeric characters followed by 5 blanks or no
 19      HEADER     Contact Phone Number format is invalid          more than 15 numeric characters total. Format in rule (AAA)XXX-                  Error
                                                                    XXXX-EEEEE
                                                                    Must contain alpha/numeric characters. No character limitation or
 20      HEADER     Contact E-mail format is invalid                                                                                            Warning
                                                                    formatting mentioned.
 21      HEADER     Contact Address is empty                        Must contain no more than 40 alpha/numeric characters                            Error
 22      HEADER     Contact City is empty                           Must contain no more than 25 alpha characters                                    Error
 23      HEADER     Contact State is invalid                        Must contain 2 alpha characters using valid state abbreviation.                  Error
                                                                    Must contain at least 5 numeric characters followed using no more
 24      HEADER     Contact Zip Code format is invalid              than 4 blanks or no more than 9 numeric characters total. Format in              Error
                                                                    rule (XXXXX-XXXX)
                                                                    The same CPT or HCPCS code is listed in the file 6 or more times and
171       DATA      At least 6 procedures and all are the same
                                                                    must be verified by the reporting entity.
                                                                    The same Patient ID or Record number is reported more than one
 25     DEMOGRAPH   Duplicate Patient ID numbers exist                                                                                               Error
                                                                    in the same file
 26     DEMOGRAPH   Invalid Facility ID                             An eight to ten (8-10) digit number assigned by AHCA must be reported            Error
                                                                    Facility ID number must be the same as the Facility ID number
 27     DEMOGRAPH   Facility ID is not same as Reported in Header   reported in the Header Record, an eight to ten (8-10) digit number               Error
                                                                    assigned by AHCA.
                                                                    The Patient Social Security Number field contains a number is that
                                                                    is not a valid number recognized by the Social Security
 28     DEMOGRAPH   Social Security Number invalid                  Administration and is not the unknown exception (777777777 for                   Error
                                                                    age >2yrs or 000000000 for age <2yrs or 555555555 for foreign
                                                                    patients)
                                                                    The Patient Race field contains an invalid value. Patient Race is a
 29     DEMOGRAPH   Race not valid (Not 1,2,3,4,5,6,7,8)            required field and must contain a numeric value (1, 2, 3, 4, 5, 6, 7,            Error
                                                                    or 8)
                                                                    The patient's date of birth is after the beginning date of service or
 30     DEMOGRAPH   Birth Date is after Begin or End Date                                                                                            Error
                                                                    ending date of service
                                                                    Patient Birth Date is invalid, this is a required field and must
 31     DEMOGRAPH   Birth Date is not a valid date                  contain a value using 10 numeric characters in format YYYY-MM-                   Error
                                                                    DD. 9999-99-99 can be used for type of service=2 when efforts to
                                                                    obtain the patients date of birth are unsuccessful
                                                                    Patient Gender is invalid; this is a required field and must contain a
 32     DEMOGRAPH   Patient Sex is not Valid (1, 2, or 3)                                                                                            Error
                                                                    single numeric character




                                                                                Page 1
                                                                       The Patient's Zip Code is invalid, the code must be the five (5)
                                                                       digit US postal service zip code of the patients permanent
33    DEMOGRAPH   Invalid Patient ZIP Code                             residence, with exceptions:00009- Foreign residences , 00007-              Error
                                                                       Homeless patients, and 00000 - If unavailable

                                                                       Type of Service code is invalid, must use single numeric character
34    DEMOGRAPH   Invalid Type of Service code                         indicating type of service: 1-Ambulatory surgery or 2-Emergency            Error
                                                                       department visit

                                                                       Payer Code is invalid, must contain a valid single uppercase alpha
35    DEMOGRAPH   Invalid Payer (Outpatient)                                                                                                      Error
                                                                       character (A-P)
                                                                       Payer Code is invalid, must contain a valid single uppercase alpha
36    DEMOGRAPH   Invalid Payer (ED)                                                                                                              Error
                                                                       character (A-P)
                                                                       Use of Payer=P (unknown) is used only if payer information is not
37    DEMOGRAPH   Invalid Use of Payer P in ED Data                    available, and type of service is 2 and patient status is 07               Error

                                                                       The date at the beginning of the patient’s visit for ambulatory
128   DEMOGRAPH   Patient Visit Begin Date is not valid                surgery or the date at the time of registration in the emergency           Error
                                                                       department. A ten character field in the format: YYYY-MM-DD

                                                                       The date at the end of the patient’s visit. A ten character field in the
                                                                       format: YYYY-MM-DD. A blank field is not permitted unless type
129   DEMOGRAPH   Patient End Date is not valid                        of service is 2 indicating an emergency department visit and               Error
                                                                       patient status is 07 indicating the patient left against medical
                                                                       advice or discontinued care.
                                                                       The patient begin date MUST precede the patient end date to be
130   DEMOGRAPH   Patient End Date is before Begin Date                                                                                           Error
                                                                       valid
                                                                       Patient End Date is a required field . A blank field is only permitted
131   DEMOGRAPH   Patient End Date is Empty                                                                                                       Error
                                                                       if the type of service is 2 and patient status is 07
                                                                       Patient End Date Must fall within the reporting period in which the
132   DEMOGRAPH   Patient End Date is not in Reporting Period                                                                                     Error
                                                                       report header indicates
                                                                       The hour on a 24-hour clock during which the patient’s visit for
133   DEMOGRAPH   Hour of Arrival is Invalid                           ambulatory surgery began or during which registration in the               Error
                                                                       emergency department occurred. Must be two numeric characters
                                                                       using 00 through 23
                                                                       If reported, must contain a valid ICD-9-CM code and must be
135   DEMOGRAPH   Patient Reason for Visit Code in Invalid             entered with use of the decimal point if the valid code contains a         Error
                                                                       decimal point.
                                                                       The patient's disposition at the end of a visit indicated by a two
147   DEMOGRAPH   Invalid Patient Status Code                                                                                                     Error
                                                                       digit code as specified in Rule Chapter 59B-9, F.A.C.
                                                                       A record with a ICD-9 code indicating sudden death must have a
148   DEMOGRAPH   Diagnosis of Sudden Death, Patient Status Not 20                                                                                Error
                                                                       corresponding patient status of 20 (expired)
                                                                       Two or more records have the same SSN with different races, sex,
155   DEMOGRAPH   Same SSN, Different Race, Sex, or Date of Birth                                                                                 Error
                                                                       or date of birth
                  Visit End Date is 4 or more days after Visit Begin   The date at the end of the patient's visit is 4 or more days after the
157   DEMOGRAPH                                                                                                                                   Verify
                  Date                                                 date entered for the beginning of the patient's visit.
159   DEMOGRAPH   Year of Birth not between 1880 and This year         The patient's date of birth is before 1880                                 Error
                                                                       The patient's age is greater than 124 years, according to the date
160   DEMOGRAPH   Patient Age > 124
                                                                       of birth entered
                                                                       Each record must contain a valid ICD-9 or ICD-10 CM code
                  Primary Diagnosis is empty and Not ED Discharged     UNLESS patient status is 07 indicating that the patient left against
38       DX                                                                                                                                       Error
                  AMA                                                  medical advice or discontinued care. A blank field is permitted if
                                                                       type of service is 2 and patient status is 07
                                                                       consistent with the records of the reporting entity.



                                                                                   Page 2
                                                    Diagnosis codes must be valid ICD-9 or ICD-10 codes, entered
39   DX   Primary Diagnosis Ends in a Decimal       with use of the decimal point that is contained in the code ONLY if     Error
                                                    there is a numerical character following the decimal. The code
                                                    CANNOT end in a decimal point.
                                                    Diagnosis codes must be valid ICD-9 or ICD-10 codes, entered
40   DX   Secondary Diagnosis 1 Ends in a Decimal   with use of the decimal point that is contained in the code ONLY if     Error
                                                    there is a numerical character following the decimal. The code
                                                    CANNOT end in a decimal point.
                                                    Diagnosis codes must be valid ICD-9 or ICD-10 codes, entered
41   DX   Secondary Diagnosis 2 Ends in a Decimal   with use of the decimal point that is contained in the code ONLY if     Error
                                                    there is a numerical character following the decimal. The code
                                                    CANNOT end in a decimal point.
                                                    Diagnosis codes must be valid ICD-9 or ICD-10 codes, entered
42   DX   Secondary Diagnosis 3 Ends in a Decimal   with use of the decimal point that is contained in the code ONLY if     Error
                                                    there is a numerical character following the decimal. The code
                                                    CANNOT end in a decimal point.
                                                    Diagnosis codes must be valid ICD-9 or ICD-10 codes, entered
43   DX   Secondary Diagnosis 4 Ends in a Decimal   with use of the decimal point that is contained in the code ONLY if     Error
                                                    there is a numerical character following the decimal. The code
                                                    CANNOT end in a decimal point.
                                                    Diagnosis codes must be valid ICD-9 or ICD-10 codes, entered
44   DX   Secondary Diagnosis 5 Ends in a Decimal   with use of the decimal point that is contained in the code ONLY if     Error
                                                    there is a numerical character following the decimal. The code
                                                    CANNOT end in a decimal point.
                                                    Diagnosis codes must be valid ICD-9 or ICD-10 codes, entered
45   DX   Secondary Diagnosis 6 Ends in a Decimal   with use of the decimal point that is contained in the code ONLY if     Error
                                                    there is a numerical character following the decimal. The code
                                                    CANNOT end in a decimal point.
                                                    Diagnosis codes must be valid ICD-9 or ICD-10 codes, entered
46   DX   Secondary Diagnosis 7 Ends in a Decimal   with use of the decimal point that is contained in the code ONLY if     Error
                                                    there is a numerical character following the decimal. The code
                                                    CANNOT end in a decimal point.
                                                    Diagnosis codes must be valid ICD-9 or ICD-10 codes, entered
                                                    with use of the decimal point that is contained in the code ONLY if
47   DX   Secondary Diagnosis 8 Ends in a Decimal                                                                           Error
                                                    there is a numerical character following the decimal. The code
                                                    CANNOT end in a decimal point.
                                                    Diagnosis codes must be valid ICD-9 or ICD-10 codes, entered
48   DX   Secondary Diagnosis 9 Ends in a Decimal   with use of the decimal point that is contained in the code ONLY if     Error
                                                    there is a numerical character following the decimal. The code
                                                    CANNOT end in a decimal point.
                                                    Principal Diagnosis is a required field and must contain a valid ICD-
49   DX   Primary Diagnosis is invalid              9 or ICD-10 CM code. The code must be entered with use of               Error
                                                    decimal point.
                                                    If reported, the Secondary Diagnosis 1 Code field must contain a
50   DX   Secondary Diagnosis 1 is Invalid          valid ICD-9 or ICD-10 CM code. The code must be entered with            Error
                                                    use of decimal point.
                                                    If reported, the Secondary Diagnosis 2 Code field must contain a
51   DX   Secondary Diagnosis 2 is Invalid          valid ICD-9 or ICD-10 CM code. The code must be entered with            Error
                                                    use of decimal point.
                                                    If reported, the Secondary Diagnosis 3 Code field must contain a
52   DX   Secondary Diagnosis 3 is Invalid          valid ICD-9 or ICD-10 CM code. The code must be entered with            Error
                                                    use of decimal point.



                                                                Page 3
                                                             If reported, the Secondary Diagnosis 4 Code field must contain a
53   DX   Secondary Diagnosis 4 is Invalid                   valid ICD-9 or ICD-10 CM code. The code must be entered with         Error
                                                             use of decimal point.
                                                             If reported, the Secondary Diagnosis 5 Code field must contain a
54   DX   Secondary Diagnosis 5 is Invalid                   valid ICD-9 or ICD-10 CM code. The code must be entered with         Error
                                                             use of decimal point.
                                                             If reported, the Secondary Diagnosis 6 Code field must contain a
55   DX   Secondary Diagnosis 6 is Invalid                   valid ICD-9 or ICD-10 CM code. The code must be entered with         Error
                                                             use of decimal point.
                                                             If reported, the Secondary Diagnosis 7 Code field must contain a
56   DX   Secondary Diagnosis 7 is Invalid                   valid ICD-9 or ICD-10 CM code. The code must be entered with         Error
                                                             use of decimal point.
                                                             If reported, the Secondary Diagnosis 8 Code field must contain a
57   DX   Secondary Diagnosis 8 is Invalid                   valid ICD-9 or ICD-10 CM code. The code must be entered with         Error
                                                             use of decimal point.
                                                             If reported, the Secondary Diagnosis 9 Code field must contain a
58   DX   Secondary Diagnosis 9 is Invalid                   valid ICD-9 or ICD-10 CM code. The code must be entered with         Error
                                                             use of decimal point.
                                                             The sex of the patient does not agree with a gender specific ICD-9
59   DX   Primary Diagnosis conflicts with Patient Sex                                                                            Error
                                                             or ICD-10 CM Diagnosis Code.
                                                             The sex of the patient does not agree with a gender specific ICD-9
60   DX   Secondary Diagnosis 1 conflicts with Patient Sex                                                                        Error
                                                             or ICD-10 CM Secondary Diagnosis 1 Code.
                                                             The sex of the patient does not agree with a gender specific ICD-9
61   DX   Secondary Diagnosis 2 conflicts with Patient Sex                                                                        Error
                                                             or ICD-10 CM Secondary Diagnosis 2 Code.
                                                             The sex of the patient does not agree with a gender specific ICD-9
62   DX   Secondary Diagnosis 3 conflicts with Patient Sex                                                                        Error
                                                             or ICD-10 CM Secondary Diagnosis 3 Code.
                                                             The sex of the patient does not agree with a gender specific ICD-9
63   DX   Secondary Diagnosis 4 conflicts with Patient Sex                                                                        Error
                                                             or ICD-10 CM Secondary Diagnosis 4 Code.
                                                             The sex of the patient does not agree with a gender specific ICD-9
64   DX   Secondary Diagnosis 5 conflicts with Patient Sex                                                                        Error
                                                             or ICD-10 CM Secondary Diagnosis 5 Code.
                                                             The sex of the patient does not agree with a gender specific ICD-9
65   DX   Secondary Diagnosis 6 conflicts with Patient Sex                                                                        Error
                                                             or ICD-10 CM Secondary Diagnosis 6 Code.
                                                             The sex of the patient does not agree with a gender specific ICD-9
66   DX   Secondary Diagnosis 7 conflicts with Patient Sex                                                                        Error
                                                             or ICD-10 CM Secondary Diagnosis 7 Code.
                                                             The sex of the patient does not agree with a gender specific ICD-9
67   DX   Secondary Diagnosis 8 conflicts with Patient Sex                                                                        Error
                                                             or ICD-10 CM Secondary Diagnosis 8 Code.
                                                             The sex of the patient does not agree with a gender specific ICD-9
68   DX   Secondary Diagnosis 9 conflicts with Patient Sex                                                                        Error
                                                             or ICD-10 CM Secondary Diagnosis 9 Code.
                                                             The age of the patient does not agree with a age specific ICD-9
69   DX   Primary Diagnosis conflicts with Patient Age                                                                            Error
                                                             Diagnosis Code
                                                             The age of the patient does not agree with a age specific ICD-9
70   DX   Secondary Diagnosis 1 conflicts with Patient Age                                                                        Error
                                                             Secondary Diagnosis 1 Code
                                                             The age of the patient does not agree with a age specific ICD-9
71   DX   Secondary Diagnosis 2 conflicts with Patient Age                                                                        Error
                                                             Secondary Diagnosis 2 Code
                                                             The age of the patient does not agree with a age specific ICD-9
72   DX   Secondary Diagnosis 3 conflicts with Patient Age                                                                        Error
                                                             Secondary Diagnosis 3 Code
                                                             The age of the patient does not agree with a age specific ICD-9
73   DX   Secondary Diagnosis 4 conflicts with Patient Age                                                                        Error
                                                             Secondary Diagnosis 4 Code
                                                             The age of the patient does not agree with a age specific ICD-9
74   DX   Secondary Diagnosis 5 conflicts with Patient Age                                                                        Error
                                                             Secondary Diagnosis 5 Code
                                                             The age of the patient does not agree with a age specific ICD-9
75   DX   Secondary Diagnosis 6 conflicts with Patient Age                                                                        Error
                                                             Secondary Diagnosis 6 Code
                                                             The age of the patient does not agree with a age specific ICD-9
76   DX   Secondary Diagnosis 7 conflicts with Patient Age                                                                        Error
                                                             Secondary Diagnosis 7 Code



                                                                        Page 4
                                                                      The age of the patient does not agree with a age specific ICD-9
77       DX       Secondary Diagnosis 8 conflicts with Patient Age                                                                         Error
                                                                      Secondary Diagnosis 8 Code
                                                                      The age of the patient does not agree with a age specific ICD-9
78       DX       Secondary Diagnosis 9 conflicts with Patient Age                                                                         Error
                                                                      Secondary Diagnosis 9 Code
                                                                      Diagnosis codes must be reported only once and in order of the
79       DX       Hole in the Diagnosis Codes                                                                                              Error
                                                                      fields listed: Primary, secondary 1, secondary 2, etc.
                  Primary Diagnosis is repeated in Secondary          The same ICD diagnosis code is reported more than once on the
80       DX                                                                                                                                Error
                  Diagnosis Codes                                     same claim.
                                                                      The same ICD diagnosis code is reported more than once on the
81       DX       SDX1 is repeated in Secondary Diagnosis Codes 2-9                                                                        Error
                                                                      same claim.
                                                                      The same ICD diagnosis code is reported more than once on the
82       DX       SDX2 is repeated in Secondary Diagnosis Codes 3-9                                                                        Error
                                                                      same claim.
                                                                      The same ICD diagnosis code is reported more than once on the
83       DX       SDX3 is repeated in Secondary Diagnosis Codes 4-9                                                                        Error
                                                                      same claim.
                                                                      The same ICD diagnosis code is reported more than once on the
84       DX       SDX4 is repeated in Secondary Diagnosis Codes 5-9                                                                        Error
                                                                      same claim.
                                                                      The same ICD diagnosis code is reported more than once on the
85       DX       SDX5 is repeated in Secondary Diagnosis Codes 6-9                                                                        Error
                                                                      same claim.
                                                                      The same ICD diagnosis code is reported more than once on the
86       DX       SDX6 is repeated in Secondary Diagnosis Codes 7-9                                                                        Error
                                                                      same claim.
                                                                      The same ICD diagnosis code is reported more than once on the
87       DX       SDX7 is repeated in Secondary Diagnosis Codes 8-9                                                                        Error
                                                                      same claim.
                                                                      The same ICD diagnosis code is reported more than once on the
88       DX       SDX8 is repeated in Secondary Diagnosis Code 9                                                                           Error
                                                                      same claim.
                                                                      Diagnosis codes must be reported only once and in order of the
89       DX       Hole in the Diagnosis Codes                                                                                              Error
                                                                      fields listed: Primary, secondary 1, secondary 2, etc.
                                                                      Diagnosis code and Reason for Visit Code fields must contain a
90     ECODE      E-codes in Diagnosis or Reason for Visit Codes                                                                           Error
                                                                      valid ICD-9 code; E-codes must be reported ONLY in E-code field
                                                                      If not space filled, must be a valid ICD-9-CM or ICD-10-CM cause
141    ECODE      E-Code1 is not a valid E-Code                       of injury code for the reporting period. The code must be entered    Error
                                                                      with use of a decimal point that is included in code.
                                                                      If not space filled, must be a valid ICD-9-CM or ICD-10-CM cause
142    ECODE      E-Code2 is not a valid E-Code                       of injury code for the reporting period. The code must be entered    Error
                                                                      with use of a decimal point that is included in code.
                                                                      If not space filled, must be a valid ICD-9-CM or ICD-10-CM cause
143    ECODE      E-Code3 is not a valid E-Code                       of injury code for the reporting period. The code must be entered    Error
                                                                      with use of a decimal point that is included in code.
                                                                      An external cause of injury code cannot be used more than once for
144    ECODE      E-Code 1 is Repeated in E-Codes 2-3                                                                                      Error
                                                                      each visit reported.
                                                                      An external cause of injury code cannot be used more than once for
145    ECODE      E-Code 2 is Repeated in E-Code 3                                                                                         Error
                                                                      each visit reported.
                                                                      ICD E-codes should be reported in order as specified by the field
146    ECODE      Hole in the E-Codes                                                                                                      Error
                                                                      name, i.e. E-code 1, 2, 3
                                                                      Field must contain a valid physician ID in format ME12345,
150   PHYSICIAN   Invalid Attending Physician ID                                                                                           Error
                                                                      ARNP1234567, OS1234 with no zero fill or leading zeros
                                                                      Field must contain a valid physician ID in format ME12345,
151   PHYSICIAN   Invalid Performing Physician ID                                                                                          Error
                                                                      ARNP1234567, OS1234 with no zero fill or leading zeros
                                                                      Field must contain a valid physician ID in format ME12345,
152   PHYSICIAN   Invalid Other Physician ID                                                                                               Error
                                                                      ARNP1234567, OS1234 with no zero fill or leading zeros
                                                                      A record with a Performing Physician must have a corresponding
153   PHYSICIAN   Performing Physician without Principal Procedure                                                                         Error
                                                                      Principal CPT or HCPCS procedure code




                                                                                  Page 5
                                                                     Principal Procedure is not an Evaluation & Management code
                  Non Eval Principal Procedure without Performing    (range 99201-99499) with service code=2 and Performing
154   PHYSICIAN                                                      Physician is blank. If Principal Procedure Code is in range 10000-      Error
                  Physician
                                                                     69999, inclusive, or between 93500-93599 and type of service=1,
                                                                     then a valid performing physician is required
                                                                     Must contain a valid CPT code between 10000 and 69999, inclusive,
91    PROCEDURE   Primary Procedure not in collected Range for OP    or between 93500 and 93599, inclusive if type of service is “1”         Error
                                                                     indicating ambulatory surgery.
                                                                     Must contain a valid HCPCS or CPT evaluation and management
                  Primary Procedure is empty and not ED Discharged   code, UNLESS type of service is 2 indicating an emergency
92    PROCEDURE                                                                                                                              Error
                  AMA                                                department visit and patient status is 07 indicating that the patient
                                                                     left against medical advice or discontinued care.
                                                                     Must contain a valid CPT Code between 10000 and 69999,
93    PROCEDURE   Primary Procedure is Invalid                       inclusive, or between 93500 and 93599, inclusive if type of service     Error
                                                                     is 1 indicating ambulatory surgery or a valid HCPCS or CPT
                                                                     evaluation and management code if type of service is 2
                                                                     If reported, the Secondary Procedure 1 Code field must contain a
94    PROCEDURE   Secondary Procedure 1 is Invalid                                                                                           Error
                                                                     valid CPT or HCPCS code.
                                                                     If reported, the Secondary Procedure 2 Code field must contain a
95    PROCEDURE   Secondary Procedure 2 is Invalid                                                                                           Error
                                                                     valid CPT or HCPCS code.
                                                                     If reported, the Secondary Procedure 3 Code field must contain a
96    PROCEDURE   Secondary Procedure 3 is Invalid                                                                                           Error
                                                                     valid CPT or HCPCS code.
                                                                     If reported, the Secondary Procedure 4 Code field must contain a
97    PROCEDURE   Secondary Procedure 4 is Invalid                                                                                           Error
                                                                     valid CPT or HCPCS code.
                                                                     If reported, the Secondary Procedure 5 Code field must contain a
98    PROCEDURE   Secondary Procedure 5 is Invalid                                                                                           Error
                                                                     valid CPT or HCPCS code.
                                                                     If reported, the Secondary Procedure 6 Code field must contain a
99    PROCEDURE   Secondary Procedure 6 is Invalid                                                                                           Error
                                                                     valid CPT or HCPCS code.
                                                                     If reported, the Secondary Procedure 7 Code field must contain a
100   PROCEDURE   Secondary Procedure 7 is Invalid                                                                                           Error
                                                                     valid CPT or HCPCS code.
                                                                     If reported, the Secondary Procedure 8 Code field must contain a
101   PROCEDURE   Secondary Procedure 8 is Invalid                                                                                           Error
                                                                     valid CPT or HCPCS code.
                                                                     If reported, the Secondary Procedure 9 Code field must contain a
102   PROCEDURE   Secondary Procedure 9 is Invalid                                                                                           Error
                                                                     valid CPT or HCPCS code.
                                                                     The sex of the patient does not agree with the gender specific
103   PROCEDURE   Primary Procedure Conflicts with Patient Sex                                                                               Error
                                                                     Primary CPT or HCPCS code
                                                                     The sex of the patient does not agree with the gender specific
104   PROCEDURE   Secondary Procedure 1 Conflicts with Patient Sex                                                                           Error
                                                                     Secondary CPT or HCPCS Procedure 1 code
                                                                     The sex of the patient does not agree with the gender specific
105   PROCEDURE   Secondary Procedure 2 Conflicts with Patient Sex                                                                           Error
                                                                     Secondary CPT or HCPCS Procedure 2 code
                                                                     The sex of the patient does not agree with the gender specific
106   PROCEDURE   Secondary Procedure 3 Conflicts with Patient Sex                                                                           Error
                                                                     Secondary CPT or HCPCS Procedure 3 code
                                                                     The sex of the patient does not agree with the gender specific
107   PROCEDURE   Secondary Procedure 4 Conflicts with Patient Sex                                                                           Error
                                                                     Secondary CPT or HCPCS Procedure 4 code
                                                                     The sex of the patient does not agree with the gender specific
108   PROCEDURE   Secondary Procedure 5 Conflicts with Patient Sex                                                                           Error
                                                                     Secondary CPT or HCPCS Procedure 5 code
                                                                     The sex of the patient does not agree with the gender specific
109   PROCEDURE   Secondary Procedure 6 Conflicts with Patient Sex                                                                           Error
                                                                     Secondary CPT or HCPCS Procedure 6 code
                                                                     The sex of the patient does not agree with the gender specific
110   PROCEDURE   Secondary Procedure 7 Conflicts with Patient Sex                                                                           Error
                                                                     Secondary CPT or HCPCS Procedure 7 code
                                                                     The sex of the patient does not agree with the gender specific
111   PROCEDURE   Secondary Procedure 8 Conflicts with Patient Sex                                                                           Error
                                                                     Secondary CPT or HCPCS Procedure 8 code
                                                                     The sex of the patient does not agree with the gender specific
112   PROCEDURE   Secondary Procedure 9 Conflicts with Patient Sex                                                                           Error
                                                                     Secondary CPT or HCPCS Procedure 8 code

                                                                                 Page 6
                                                                       The sex of the patient does not agree with the gender specific
136   PROCEDURE   Principal ICD-9 Procedure Code is Invalid                                                                             Error
                                                                       Secondary CPT or HCPCS Procedure 8 code
137                                                                    The sex of the patient does not agree with the gender specific
      PROCEDURE   Secondary ICD-9 Procedure Code 1 is Invalid                                                                           Error
                                                                       Secondary CPT or HCPCS Procedure 8 code
138                                                                   The sex of the patient does not agree with the gender specific
      PROCEDURE   Secondary ICD-9 Procedure Code 2 is Invalid                                                                           Error
                                                                      Secondary CPT or HCPCS Procedure 8 code
139                                                                   The sex of the patient does not agree with the gender specific
      PROCEDURE   Secondary ICD-9 Procedure Code 3 is Invalid                                                                           Error
                                                                      Secondary CPT or HCPCS Procedure 8 code
140                                                                   The sex of the patient does not agree with the gender specific
      PROCEDURE   Secondary ICD-9 Procedure Code 4 is Invalid                                                                           Error
                                                                      Secondary CPT or HCPCS Procedure 8 code
                                                                      The sex of the patient does not agree with the gender specific
161   PROCEDURE   Primary Procedure Ends in a Decimal                                                                                   Error
                                                                      Secondary CPT or HCPCS Procedure 8 code
                                                                      The sex of the patient does not agree with the gender specific
162   PROCEDURE   Secondary Procedure 1 Ends in a Decimal                                                                               Error
                                                                      Secondary CPT or HCPCS Procedure 8 code
                                                                      The sex of the patient does not agree with the gender specific
163   PROCEDURE   Secondary Procedure 2 Ends in a Decimal                                                                               Error
                                                                      Secondary CPT or HCPCS Procedure 8 code
                                                                      The sex of the patient does not agree with the gender specific
164   PROCEDURE   Secondary Procedure 3 Ends in a Decimal                                                                               Error
                                                                      Secondary CPT or HCPCS Procedure 8 code
                                                                      The sex of the patient does not agree with the gender specific
165   PROCEDURE   Secondary Procedure 4 Ends in a Decimal                                                                               Error
                                                                      Secondary CPT or HCPCS Procedure 8 code
                                                                      The sex of the patient does not agree with the gender specific
166   PROCEDURE   Secondary Procedure 5 Ends in a Decimal                                                                               Error
                                                                      Secondary CPT or HCPCS Procedure 8 code
                                                                      The sex of the patient does not agree with the gender specific
167   PROCEDURE   Secondary Procedure 6 Ends in a Decimal                                                                               Error
                                                                      Secondary CPT or HCPCS Procedure 8 code
                                                                      The sex of the patient does not agree with the gender specific
168   PROCEDURE   Secondary Procedure 7 Ends in a Decimal                                                                               Error
                                                                      Secondary CPT or HCPCS Procedure 8 code
                                                                      The sex of the patient does not agree with the gender specific
169   PROCEDURE   Secondary Procedure 8 Ends in a Decimal                                                                               Error
                                                                      Secondary CPT or HCPCS Procedure 8 code
                                                                      The sex of the patient does not agree with the gender specific
170   PROCEDURE   Secondary Procedure 9 Ends in a Decimal                                                                               Error
                                                                      Secondary CPT or HCPCS Procedure 8 code
                                                                      Zero (0) dollar or negative amounts are not permitted unless
113      REV      Pharmacy Charge is not Numeric or is less than $0                                                                     Error
                                                                      verified separately by reporting entity
                                                                      Zero (0) dollar or negative amounts are not permitted unless
114      REV      Med Surg Charge is not Numeric or is less than $0                                                                     Error
                                                                      verified separately by reporting entity
                                                                      Zero (0) dollar or negative amounts are not permitted unless
115      REV      Laboratory Charge is not Numeric or is less than $0                                                                   Error
                                                                      verified separately by reporting entity
                  Radiology/Imaging Charge is not Numeric or is less Zero (0) dollar or negative amounts are not permitted unless
116      REV                                                                                                                            Error
                  than $0                                             verified separately by reporting entity
                                                                      Zero (0) dollar or negative amounts are not permitted unless
117      REV      Cardiology Charge is not Numeric or is less than $0                                                                   Error
                                                                      verified separately by reporting entity
                  Operating Room Charge is not Numeric or is less     Zero (0) dollar or negative amounts are not permitted unless
118      REV                                                                                                                            Error
                  than $0                                             verified separately by reporting entity
                                                                      Zero (0) dollar or negative amounts are not permitted unless
119      REV      Anesthesia Charge is not Numeric or is less than $0                                                                   Error
                                                                      verified separately by reporting entity
                  Recovery Room Charge is not Numeric or is less      Zero (0) dollar or negative amounts are not permitted unless
120      REV                                                                                                                            Error
                  than $0                                             verified separately by reporting entity
                  Emergency Room Charge is not Numeric or is less Zero (0) dollar or negative amounts are not permitted unless
121      REV                                                                                                                            Error
                  than $0                                             verified separately by reporting entity
                  Treatment/Observ. Charge is not Numeric or is less Zero (0) dollar or negative amounts are not permitted unless
122      REV                                                                                                                            Error
                  than $0                                             verified separately by reporting entity
                                                                      Zero (0) dollar or negative amounts are not permitted unless
123      REV      Other Charge is not Numeric or is less than $0                                                                        Error
                                                                      verified separately by reporting entity
                                                                      Zero (0) dollar or negative amounts are not permitted unless
124      REV      Total Charge is not Numeric or is less than $0                                                                        Error
                                                                      verified separately by reporting entity

                                                                                   Page 7
                                                                     The sum of all sub-charges reported must equal total charges,
125    REV      Total Charge not within $11 of Sum of Sub-Charges                                                                          Error
                                                                     plus or minus eleven dollars.
                                                                     Total charges exceed $50,000 and must be verifed by the reporting
126    REV      Outpatient Bill with Total Charge>$50,000                                                                                  Verify
                                                                     entity.
                                                                     Total charges exceed $100,000 and must be verifed by the
127    REV      E.D. Bill with Total Charge>$100,000                                                                                       Verify
                                                                     reporting entity.
                                                                     The total charge report is $0 and the patient discharge status was
158    REV      Total Charge=0 and Not ED Discharged AMA                                                                                   Error
                                                                     not coded as AMA (07)
                                                                     The total number of records that are reported in the trailer record
                Number of Records field in Trailer not the Number in
149   TRAILER                                                        MUST match the total number of records in the data file, excluding    Error
                DATA
                                                                     the header and trailer records.




                                                                                 Page 8
                                                             THRESHOLD DICTIONARY
                                                                                                                                                             Audit
Audit   # Allowance      %                          Audit*                                                 Audit Description
                                                                                                                                                            Severity
    1          35.0%         Out of State Allowance                               Monitors the use of out of state patients                                  Verify
    2          1.0%          Principal Payer=M (Other)                            Monitors the use of 'other' principal payer code                           Verify
    3          50.0%         Principal Payer=N (Charity)                          Monitors the use of 'charity' principal payer code                         Verify
    4          10.0%         Race=7 (Other)                                       Monitors the use of 'other' race code                                      Verify
    5          10.0%         Race=8 (No Response)                                 Monitors the use of 'no response' race code                                Verify
    6          1.0%          Patient Sex=3 (Unknown)                              Monitors the use of 'unknown' patient sex                                  Verify
    7          10.0%         Date of Birth=9999-99-99 (ED only)                   Monitors the use of 'unknown' date of birth for ED visits (service code=2) Verify
    8          5.0%          Hour of Arrival=99                                   Monitors the use of 'unknown' arrival time                                 Verify
    9          5.0%          Primary Diagnosis of Injury without E-code           Flags each case where primary diagnosis is reported without an E-code Verify
                                                                                  Flags each case where the hour of arrival is at/after 11pm and
                50.0%        Patient Arrived at or after 11pm and departed same day                                                                          Verify
   10                                                                             visit begin and end date are the same
   11           1.0%         Attending Physician="NA"                             Monitors the use of 'unknown' attending physician license numbers          Verify
   12           5.0%         Empty Reason for Visit Code                          Flags each case where the reason for visit field is empty                  Verify

*The threshold audit captures the those cases where the threshold percentage has been exceeded. Each of the above threshold audits has a specified
threshold percentage which represents the maximum % of cases allowed per total cases submitted that can be reported for that audit before it is flagged for
verification.
                                                                                                                                                       Revised 9/06




                                                                                              Page 9

								
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