BR-014: Relationship dates must be valid and non-overlapping¶
Field
Value
Statement
A provider relationship requires an effective date, cannot expire before it becomes effective, and cannot overlap an existing relationship of the same type.
Trigger
A provider relationship is inserted or updated.
Enforcement
clsProviderRelationship validates dates and checks for duplicate overlapping relationships.
BR-016: MCO membership period must fall within the MCO plan's active date range¶
Field
Value
Statement
A provider's MCO membership effective/expiration period must fall entirely within the effective/expiration dates of the referenced MCO plan.
Trigger
A provider MCO membership is inserted or updated with an effective date, and optionally an expiration date.
Enforcement
clsProviderMCOMembership.ActiveEffDate compares the membership period to clsMCOPlan.GetMCOPlan(...).EffDate/ExpDate, treating a blank plan or membership expiration as open-ended.
Outcome
The save fails when the membership period extends outside the plan's active dates.
BR-017: MCO membership expiration cannot precede an effective service contract's expiration¶
Field
Value
Statement
When a provider MCO membership record is being expired, its expiration date cannot be earlier than the expiration date of an effective provider service contract for the same MCO plan and location.
Trigger
A dirty provider MCO membership is saved with an ExpDate populated.
Enforcement
clsProviderMCOMembership.BeforeContractExpDate calls IsServiceContractEffective, which counts PROVIDER_SERVICE_CONTRACT rows for the same location/plan whose expiration (or an open-ended NVL to 31-Dec-2999) exceeds the proposed membership expiration date.
Outcome
The save fails while an effective service contract would outlive the membership record.
BR-018: MCO membership admin fee flag and rate must be mutually consistent¶
Field
Value
Statement
A provider MCO membership's admin-fee rate must be present and no greater than 1.000 when the admin fee flag is enabled, and must be blank when the flag is not enabled.
Enforcement
clsProviderMCOMembership.ValidAdminFeeRate.
Outcome
Membership rows with an inconsistent admin-fee flag/rate combination cannot be saved.
BR-020: Provider service contract pricing fields are mutually exclusive¶
Field
Value
Statement
A provider service contract's discount rate, additional-fee discount rate, and maximum charge amount must together total more than zero, but no more than one of the three may be populated.
Enforcement
clsProviderServiceContract.AmtOrRateRequired and AmtAndRateNotZero.
Outcome
Contract rows missing all three pricing fields, or populating more than one, cannot be saved.
BR-021: Package-priced and equipment service contract rows carry additional cross-field requirements¶
Field
Value
Statement
A provider service contract identifying a package-priced service (service code Z) requires an MCO plan and disallows discount-rate fields; a contract identifying equipment or a service type equal to E requires a purchase code, and other rows must leave the purchase code blank. Service type code and CBP service code are mutually exclusive, and exactly one is required.
BR-022: Provider ineligibility periods must fall within a reasonable, non-future date range¶
Field
Value
Statement
A provider ineligibility period's start date cannot precede 01/01/1850 or fall in the future, and its termination date cannot precede the start date, fall in the future, or be more than 30 years in the past.
Enforcement
clsProviderIneligibilityPeriod.UnreasonableStartDate, LateStartDate, ValidTerminationDate, LateTerminationDate, and EarlyTerminationDate.
Outcome
Ineligibility periods with an out-of-range date are rejected.
BR-023: Provider DCBS cost/charge factor must be between 0.000 and 1.000 inclusive¶
Field
Value
Statement
A provider location's DCBS cost/charge factor must be between 0.000 and 1.000 inclusive, and its effective/expiration dates must stay within -30 years to +10 years of today with the expiration not preceding the effective date.
Enforcement
clsProviderDcbsCostCharge.ValidCostChargeFactor, EarlyEffDate, LateEffDate, LateExpDate, and ValidEffExpDate.
Outcome
Cost/charge records with an out-of-range factor or date cannot be saved.
BR-026: A provider address expiration date cannot be removed while a later address of the same type exists¶
Field
Value
Statement
A provider address that has already been assigned an expiration date cannot have that expiration date cleared if a later address of the same address type already exists.
Enforcement
clsProviderAddress.ValidateExpDate.
Outcome
The save is rejected with "Error: Expiration date cannot be removed."