Claim Edit Type
| Business Data Model Data Model |
| Description | The result of a validation test that is performed on a claim line using an outpatient code editor (OCE). The OCE processes HCPCS/CPT procedures for the claim line, evaluating the procedure codes, revenue codes, and modifiers. |
| Attributes | |
| Claim Edit Type |
|
| Relationship | |
 Claim Line OCE Edit_Claim Line_FK |
|
| Dependencies | |
 NONE |
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| Reverse Dependencies | |
| |
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| Attribute Details |
Claim Edit Type
| Description | Indicates the nature of the outpatient code editor (OCE) edit for the claim line that results from processing the HCPCS/CPT procedures for a record after evaluating all the codes, revenue codes, and modifiers. The codes listed as examples are not an exhaustive or current list, refer to OPPS Final Rule. Outpatient code editor (OCE) edits also exist at the pre-procedure level. For example: Invalid diagnosis code Diagnosis and age conflict Diagnosis and sex conflict Medicare secondary payer alert E-code as reason for visit Invalid procedure code Procedure and age conflict |
| Data Type | Standards - Data Domains.ddm/Data Domains/Enumeration [VARCHAR(20)] |
| Is Part Of PrimaryKey | false |
| Is Required | false |
| Is Derived | false |
| Is Surrogate Key | false |
| Relationship Details |
Claim Line OCE Edit_Claim Line_FK
| Is Identifying Relationship | true |
| Child Table | Claim Line OCE Edit |
| Child Multiplicity | ZERO_TO_MANY |
| Child Referential Integrity: On Delete | NONE |
| Child Referential Integrity: On Insert | NONE |
| Child Referential Integrity: On Update | NONE |
| Parent Table | Claim Line |
| Parent Multiplicity | ONE |
| Parent Referential Integrity: On Delete | NONE |
| Parent Referential Integrity: On Insert | NONE |
| Parent Referential Integrity: On Update | NONE |
| Business Data Model Data Model |