Validation Rules

A validation rule is a user defined validation of the data elements on the authorization, for example a combination check for procedures and diagnoses. The result of a validation evaluating to true, is that a message is attached to the authorization. The message can be used to pend or deny the authorization.

A setup for validation rule has the following fields:

Table 1. Validation Rules

Field	Description
Code	The code of the validation rule
Description	The description of the validation rule
Dynamic Logic Condition	The dynamic logic condition of the signature 'Validation Rule'. If the condition evaluates as true, then the specified dynamic function is executed and the message is attached to the authorization. No condition implies validation evaluation as true
Dynamic Logic Function	The dynamic logic function of the signature 'Validation Rule'. The authorization can be modified by this function
Message	The message that is attached to the authorization when the dynamic logic condition evaluates to true. Substitution parameters for the message are as follows: 0 - Authorization 1 - Requested for (Person or Object) 2 - Service Provider 3 - Service Specialty 4 - Location Provider
Inherit?	Should the message be inherited by the claim line in Claims?
Enabled?	Is the validation rule enabled for execution?