January 14th, 2025

Specification

Claims

Claim Rules Update for MeasDetailID with Exemption Enhancements

Updated Claims data rule exemption criteria for Claim.MeasDetailID for measures where ApplicationDate is before 1/1/2024 to align with the recent date rule adjustments.


  • Old validation:

    Claim.MeasDetailID is not a 'restricted permutation' when Claim.ClaimType equals 'Deemed' and Program.ProgramSegment is populated and Program.ProgramSegment does not equal 'Equity'.


    New validation:

    Claim.MeasDetailID is not a 'restricted permutation' when Claim.ClaimType equals 'Deemed' and Program.ProgramSegment is populated and Program.ProgramSegment does not equal 'Equity' and ApplicationDate > 12/31/2023.