VALIDITY
EDITS
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1-250-01V
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MUST BE A VALID FREQUENCY CODE
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1-250-02V
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IF DRG NUMBER IS NOT BLANK
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AND TYPE OF SUBMISSION
=
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A
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ADJUSTMENT TO TED RECORD DATA OR
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|
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C
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COMPLETE CANCELLATION TO TED
RECORD DATA OR
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I
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INITIAL TED RECORD SUBMISSION OR
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O
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ZERO PAYMENT TED RECORD DUE
TO 100% OHI OR
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|
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R
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RESUBMISSION OF AN INITIAL
TED RECORD
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AND FREQUENCY
CODE =
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2
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INTERIM-INITIAL OR
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3
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INTERIM-INTERIM OR
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4
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INTERIM-FINAL
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THEN THE FREQUENCY
CODE SUBMISSION MUST FOLLOW THE DIRECTIONS IN THE TABLE BELOW
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FREQUENCY
CODE
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PREVIOUS TED RECORD FREQUENCY
CODE
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2
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= 2 OR NO PREVIOUS
TED RECORD
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3
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= 2 OR 3 (PREVIOUS
TED RECORD MUST EXIST)
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4
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= 2, 3, OR 4 (PREVIOUS
TED RECORD MUST EXIST)
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Relational
Edits
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1-250-01R
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IF PATIENT STATUS =
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30
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STILL A PATIENT
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AND AMOUNT ALLOWED
(TOTAL) ≠ ZERO
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OR OCCURRENCE
OF SPECIAL PROCESSING CODE =
|
T
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MEDICARE/TRICARE DUAL ENTITLEMENT
(SECOND PAYER) AND BEGIN DATE OF CARE ≥ 10/01/2001 OR
|
|
|
FS
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TFL (SECOND PAYER)
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THEN FREQUENCY
CODE MUST =
|
2
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INTERIM-INITIAL OR
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|
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3
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INTERIM-INTERIM
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UNLESS TYPE OF
INSTITUTION =
|
70
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HHA
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THEN FREQUENCY
CODE MUST =
|
2
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INTERIM-INITIAL OR
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|
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3
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INTERIM-INTERIM OR
|
|
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7
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REPLACEMENT OF PRIOR CLAIM OR
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8
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VOID/CANCEL OF PRIOR CLAIM OR
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|
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9
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FINAL CLAIM FOR HHA EPISODE
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1-250-02R
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IF PATIENT STATUS =
|
01
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DISCHARGED OR
|
|
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02
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TRANSFERRED OR
|
|
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20
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EXPIRED
|
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THEN FREQUENCY
CODE MUST =
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0
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NON-PAYMENT/ZERO CLAIM OR
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|
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1
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ADMIT THROUGH DISCHARGE OR
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4
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INTERIM-FINAL OR
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|
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5
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LATE CHARGE(S) OR
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7
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REPLACEMENT OF PRIOR CLAIM OR
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8
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VOID/CANCELLATION OF PRIOR
CLAIM OR
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|
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9
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FINAL CLAIM FOR HHA PPS EPISODE
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1-250-03R
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IF PRICING RATE CODE =
|
H
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TRICARE DRG REIMBURSEMENT WITH
SHORT STAY OUTLIER
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THEN FREQUENCY
CODE MUST =
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1
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ADMIT THROUGH DISCHARGE
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1-250-05R
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IF FREQUENCY CODE =
|
5
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LATE CHARGE(S)
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THEN AMOUNT ALLOWED
(TOTAL) MUST = ZERO FOR ALL OCCURRENCE/LINE ITEMS
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