{ "name": "EOB - CARIN Blue Button - Inpatient", "mnemonic": "EOB_C4BB_INPATIENT", "tenantUid": "00000000-0000-0000-0000-000000000000", "description": "PIQI Rubric for Explanation of Benefits (EOBs) for Inpatient services based on the CARIN IG for Blue Button (C4BB) implementation guide.", "version": 2026, "authorityName": "None", "model": { "name": "Patient EOB Model", "mnemonic": "PAT_EOB_V1", "version": 1 }, "source": { "name": "PIQI Alliance", "mnemonic": "PIQI.ALLIANCE" }, "criteria": [ { "sequence": 1, "description": null, "entity": "CLAIM_UNIQUE_ID", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "medical claim identifier is populated", "failureNameOverride": "medical claim identifier is populated", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 2, "description": null, "entity": "CLAIM_IDENTIFIER_TYPE", "samMnemonic": "ATTR_INLIST", "samNameOverride": "medical claim identifier type is valid value", "failureNameOverride": "medical claim identifier type is not valid value", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "LIST_CSV", "parameterValue": "payerid,naiccode,pat,um,uc", "parameterValueTypeName": "Simple List (CSV)", "parameterName": "List CSV" } ], "conditionalSamParameters": [] }, { "sequence": 3, "description": null, "entity": "CLAIM_PROCESSING_STATUS_CODE", "samMnemonic": "ATTR_INLIST", "samNameOverride": "medical claim status is valid value", "failureNameOverride": "medical claim status is not valid value", "conditionalSam": "ATTR_ISPOPULATED", "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "LIST_CSV", "parameterValue": "active,cancelled,draft,entered-in-error,entered in error", "parameterValueTypeName": "Simple List (CSV)", "parameterName": "List CSV" } ], "conditionalSamParameters": [] }, { "sequence": 4, "description": null, "entity": "CLAIM_TYPE_CODE", "samMnemonic": "ATTR_INLIST", "samNameOverride": "medical claim type is 'institutional'", "failureNameOverride": "medical claim type is not 'institutional'", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "LIST_CSV", "parameterValue": "institutional", "parameterValueTypeName": "Simple List (CSV)", "parameterName": "List CSV" } ], "conditionalSamParameters": [] }, { "sequence": 5, "description": null, "entity": "CLAIM_SUB_TYPE", "samMnemonic": "ATTR_INLIST", "samNameOverride": "medical claim type is valid value", "failureNameOverride": "medical claim type is not valid value", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "LIST_CSV", "parameterValue": "inpatient,outpatient", "parameterValueTypeName": "Simple List (CSV)", "parameterName": "List CSV" } ], "conditionalSamParameters": [] }, { "sequence": 6, "description": null, "entity": "CLAIM_USE", "samMnemonic": "ATTR_INLIST", "samNameOverride": "medical claim use is valid value", "failureNameOverride": "medical claim use is valid value", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "LIST_CSV", "parameterValue": "claim,preauthorization,predetermination", "parameterValueTypeName": "Simple List (CSV)", "parameterName": "List CSV" } ], "conditionalSamParameters": [] }, { "sequence": 7, "description": null, "entity": "CLAIM_START_DATE", "samMnemonic": "ATTR_ISPASTDATE", "samNameOverride": "medical claim start date is valid past date", "failureNameOverride": "medical claim start date is not valid past date", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 8, "description": null, "entity": "CLAIM_END_DATE", "samMnemonic": "ATTR_ISPASTDATE", "samNameOverride": "medical claim is valid past date", "failureNameOverride": "medical claim is not valid past date", "conditionalSam": "ATTR_ISPOPULATED", "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 9, "description": null, "entity": "CLAIM_ADJUDICATION_DATE", "samMnemonic": "ATTR_ISPASTDATE", "samNameOverride": "medical claim adjudication date is valid past date", "failureNameOverride": "medical claim adjudication date is not valid past date", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 10, "description": null, "entity": "CLAIM_PAYEE", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "medical claim payee is populated", "failureNameOverride": "medical claim payee is not populated", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 11, "description": null, "entity": "CLAIM_PAYEE_TYPE_CODE", "samMnemonic": "ATTR_INLIST", "samNameOverride": "claim payee type is valid value", "failureNameOverride": "claim payee type is not valid value", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "LIST_CSV", "parameterValue": "beneficiary,subscriber,provider,other", "parameterValueTypeName": "Simple List (CSV)", "parameterName": "List CSV" } ], "conditionalSamParameters": [] }, { "sequence": 12, "description": null, "entity": "CLAIM_PAYMENT_STATUS_CODE", "samMnemonic": "ATTR_INLIST", "samNameOverride": "claim payment status is valid value", "failureNameOverride": "claim payment status is not valid value", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "LIST_CSV", "parameterValue": "queued,complete,error,partial", "parameterValueTypeName": "Simple List (CSV)", "parameterName": "List CSV" } ], "conditionalSamParameters": [] }, { "sequence": 13, "description": "We currently do not have access to UB04 codes", "entity": "CLAIM_BILL_FACILITY_TYPE_CODE", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "claim bill type is populated", "failureNameOverride": "claim bill type is not populated", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 14, "description": null, "entity": "MEMB_ID", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "member id is populated", "failureNameOverride": "member id is not populated", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 15, "description": null, "entity": "MEMB_IDTYPE", "samMnemonic": "ATTR_INLIST", "samNameOverride": "member id type is valid value", "failureNameOverride": "member id type is not valid value", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "LIST_CSV", "parameterValue": "um,pat,MB,MR", "parameterValueTypeName": "Simple List (CSV)", "parameterName": "List CSV" } ], "conditionalSamParameters": [] }, { "sequence": 16, "description": null, "entity": "MEMB_UNIQUEID", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "member unique id is populated", "failureNameOverride": "member unique id is not populated", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 17, "description": null, "entity": "MEMB_BIRTHSEX", "samMnemonic": "ATTR_INLIST", "samNameOverride": "member sex is valid value", "failureNameOverride": "member sex is valid not value", "conditionalSam": "ATTR_ISPOPULATED", "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "LIST_CSV", "parameterValue": "male,female,other,unknown", "parameterValueTypeName": "Simple List (CSV)", "parameterName": "List CSV" } ], "conditionalSamParameters": [] }, { "sequence": 18, "description": null, "entity": "MEMB_DOB", "samMnemonic": "ATTR_ISPASTDATE", "samNameOverride": "member date of birth is valid past date", "failureNameOverride": "member date of birth is not valid", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 19, "description": null, "entity": "COVER_PLANID", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "plan identifier is populated", "failureNameOverride": "plan identifier is not populated", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 20, "description": null, "entity": "COVER_GROUPID", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "group identifier is populated", "failureNameOverride": "group identifier is not populated", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 21, "description": null, "entity": "COVER_STATUS", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "coverage status is populated", "failureNameOverride": "coverage status is not populated", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 22, "description": null, "entity": "COVER_RELATION", "samMnemonic": "ATTR_INLIST", "samNameOverride": "subscriber relationship is valid value", "failureNameOverride": "subscriber relationship is not valid value", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "LIST_CSV", "parameterValue": "child,parent,spouse,common,other,self,injured", "parameterValueTypeName": "Simple List (CSV)", "parameterName": "List CSV" } ], "conditionalSamParameters": [] }, { "sequence": 23, "description": null, "entity": "CLAIM_LAST_UPDATE_DATE", "samMnemonic": "ATTR_ISTIMESTAMP", "samNameOverride": "last update is valid timestamp", "failureNameOverride": "last update is valid not timestamp", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 24, "description": null, "entity": "CLAIM_ADJUSTED_REL", "samMnemonic": "ATTR_INLIST", "samNameOverride": "adjusted relationship is valid value", "failureNameOverride": "adjusted relationship is not valid value", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "LIST_CSV", "parameterValue": "prior,replacedby", "parameterValueTypeName": "Simple List (CSV)", "parameterName": "List CSV" } ], "conditionalSamParameters": [] }, { "sequence": 25, "description": null, "entity": "CLAIM_PAID_DATE", "samMnemonic": "ATTR_ISDATE", "samNameOverride": "paid date is valid date", "failureNameOverride": "paid date is not valid date", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 26, "description": null, "entity": "CLAIM_RECEIVED_DATE", "samMnemonic": "ATTR_ISPASTDATE", "samNameOverride": "received date is valid past date", "failureNameOverride": "received date is not valid past date", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 27, "description": null, "entity": "CLAIM_MEMBER_ADMISSION_DATE", "samMnemonic": "ATTR_ISPASTDATE", "samNameOverride": "member admission date is valid past date", "failureNameOverride": "member admission date is not valid past date", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 28, "description": null, "entity": "CLAIM_DISCHARGE_DATE", "samMnemonic": "ATTR_ISPASTDATE", "samNameOverride": "member discharge date is valid past date", "failureNameOverride": "member discharge date is not valid past date", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 29, "description": "Should be UB04 FL-15 but content not available for validation", "entity": "CLAIM_INPATIENT_SOURCE_ADMIN_CODE", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "inpatient source admin code is populated", "failureNameOverride": "inpatient source admin code is not populated", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 30, "description": "should be UB04 FL-14 but we do not have the content", "entity": "CLAIM_INPATIENT_ADMIN_TYPE_CODE", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "inpatient admin type code is populated", "failureNameOverride": "inpatient admin type code is not populated", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 31, "description": "should be UB04 FL-17 but we don't have the content", "entity": "CLAIM_PATIENT_DISCHARGE_STATUS_CODE", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "discharge status code is populated", "failureNameOverride": "discharge status code is not populated", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 32, "description": "Should be looking for DRG code compatibility", "entity": "CLAIM_DRG_CODE", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "DRG code is populated", "failureNameOverride": "DRG code is not populated", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 33, "description": "Should be checking x12 reason code compatibility", "entity": "CLAIM_PAYMENT_DENIAL_CODE", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "denial code is populated", "failureNameOverride": "denial code is not populated", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 34, "description": null, "entity": "CLAIM_ADJUDICATION_AMOUNT_TYPE", "samMnemonic": "ATTR_INLIST", "samNameOverride": "adj amount type is valid value", "failureNameOverride": "adj amount type is not valid value", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "LIST_CSV", "parameterValue": "submitted,copay,eligible,deductibe;,benefit,coinsurance,noncovered,priorpayerpaid,paidbypatient,paidbypatientcash,paidbypatienthealthaccount,paidtopatient,paidtoprovider,memberliability,discount,drugcost", "parameterValueTypeName": "Simple List (CSV)", "parameterName": "List CSV" } ], "conditionalSamParameters": [] }, { "sequence": 35, "description": null, "entity": "CLAIM_PAYAMT", "samMnemonic": "ATTR_ISDECIMAL", "samNameOverride": "claim payment amount is decimal", "failureNameOverride": "claim payment amount is not decimal", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 36, "description": null, "entity": "CLAIM_TOTAL_AMOUNT", "samMnemonic": "ATTR_ISDECIMAL", "samNameOverride": "claim total amount is decimal", "failureNameOverride": "claim total amount is not decimal", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 37, "description": null, "entity": "DIAG_DIAGNOSIS", "samMnemonic": "CONCEPT_ISVALIDMEMBER", "samNameOverride": "diagnosis is ICD9 or ICD10", "failureNameOverride": "diagnosis is neither ICD9 nor ICD10", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": true, "samParameters": [ { "samParameterMnemonic": "CODE_SYSTEM_CSV", "parameterValue": "WHO_ICD9CMD31,WHO_ICD10CM_FULL", "parameterValueTypeName": "Code System", "parameterName": "Code System CSV" } ], "conditionalSamParameters": [] }, { "sequence": 38, "description": null, "entity": "DIAG_DIAG_TYPE", "samMnemonic": "ATTR_INLIST", "samNameOverride": "diagnosis type is valid value", "failureNameOverride": "diagnosis type is not valid value", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "LIST_CSV", "parameterValue": "principal,other", "parameterValueTypeName": "Simple List (CSV)", "parameterName": "List CSV" } ], "conditionalSamParameters": [] }, { "sequence": 39, "description": null, "entity": "DIAG_PRESENT_ON_ADM_IND", "samMnemonic": "ATTR_INLIST", "samNameOverride": "present on admission indicator is valid value", "failureNameOverride": "present on admission indicator is not valid value", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "LIST_CSV", "parameterValue": "Y,N,U,W,1", "parameterValueTypeName": "Simple List (CSV)", "parameterName": "List CSV" } ], "conditionalSamParameters": [] }, { "sequence": 40, "description": null, "entity": "PROC_PROCEDURE", "samMnemonic": "CONCEPT_ISVALIDMEMBER", "samNameOverride": "claim procedure is ICD9p or ICD10PCS", "failureNameOverride": "claim procedure is neither ICD9p nor ICD10PCS", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": true, "samParameters": [ { "samParameterMnemonic": "CODE_SYSTEM_CSV", "parameterValue": "WHO_ICD9CMP31,WHO_ICD10PCS_FULL", "parameterValueTypeName": "Code System", "parameterName": "Code System CSV" } ], "conditionalSamParameters": [] }, { "sequence": 41, "description": null, "entity": "PROC_PROC_TYPE", "samMnemonic": "ATTR_INLIST", "samNameOverride": "procedure type is valid value", "failureNameOverride": "procedure type is not valid value", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "LIST_CSV", "parameterValue": "principal,other", "parameterValueTypeName": "Simple List (CSV)", "parameterName": "List CSV" } ], "conditionalSamParameters": [] }, { "sequence": 42, "description": null, "entity": "PROC_PERF_DATE", "samMnemonic": "ATTR_ISDATE", "samNameOverride": "procedure date is valid", "failureNameOverride": "procedure date is not valid", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 43, "description": null, "entity": "LINE_NUMBER", "samMnemonic": "ATTR_ISPOSITIVENUMBER", "samNameOverride": "line number is positive number", "failureNameOverride": "line number is not positive number", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 44, "description": "should be UB04 FL-42 codes but we dont have the content", "entity": "LINE_REVENUE_CENTER_CODE", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "revenue code is populated", "failureNameOverride": "revenue code is populated", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 45, "description": "** Need to ad HIPPS codes to terminology server and update", "entity": "LINE_PROCEDURE_CODE", "samMnemonic": "CONCEPT_ISVALIDMEMBER", "samNameOverride": "line procedure code is CPT, HCPCS or HIPPS code", "failureNameOverride": "line procedure code is not CPT, HCPCS code", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "CODE_SYSTEM_CSV", "parameterValue": "AMA_CPT,HCPCS_CODES", "parameterValueTypeName": "Code System", "parameterName": "Code System CSV" } ], "conditionalSamParameters": [] }, { "sequence": 46, "description": null, "entity": "LINE_PROCEDURE_CODE_MOD", "samMnemonic": "CONCEPT_ISVALIDMEMBER", "samNameOverride": "line procedure code modifier is CPT or HCPCS modifier", "failureNameOverride": "line procedure code modifier is not CPT or HCPCS modifier", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "CODE_SYSTEM_CSV", "parameterValue": "AMA_CPTMOD,HCPCS_MOD", "parameterValueTypeName": "Code System", "parameterName": "Code System CSV" } ], "conditionalSamParameters": [] }, { "sequence": 47, "description": null, "entity": "LINE_ALLOWED_UNITS", "samMnemonic": "ATTR_ISPOSITIVENUMBER", "samNameOverride": "allowed units is positive number", "failureNameOverride": "allowed units is not positive number", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 48, "description": "Need to be x12 code - need the content", "entity": "LINE_PAYMENT_DENIAL_CODE", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "line payment denial code is populated", "failureNameOverride": "line payment denial code is not populated", "conditionalSam": null, "scoringEffect": "Informational", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 49, "description": null, "entity": "LINE_PAYMENT_AMT", "samMnemonic": "ATTR_ISDECIMAL", "samNameOverride": "line payment amount is decimal", "failureNameOverride": "line payment amount is not decimal", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 50, "description": null, "entity": "LINE_BENEFIT_PAYMENT_STATUS", "samMnemonic": "ATTR_INLIST", "samNameOverride": "line benefit payment status is valid value", "failureNameOverride": "line benefit payment status is not valid value", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [ { "samParameterMnemonic": "LIST_CSV", "parameterValue": "innetwork,outofnetwork,other", "parameterValueTypeName": "Simple List (CSV)", "parameterName": "List CSV" } ], "conditionalSamParameters": [] }, { "sequence": 51, "description": null, "entity": "PROV_NPI", "samMnemonic": "ATTRIBUTE_IS_FORMATTED_AS_NPI", "samNameOverride": "NPI is formatted correctly", "failureNameOverride": "NPI is not formatted correctly", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 52, "description": null, "entity": "PROV_CARE_TEAM_ROLE", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "care team role is populated", "failureNameOverride": "care team role is not populated", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 53, "description": null, "entity": "PROV_PROV_CONTRACT_STATUS", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "Contract status is populated", "failureNameOverride": "Contract status is not populated", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] }, { "sequence": 54, "description": null, "entity": "PROV_SITE_OF_SERV_NET_STATUS", "samMnemonic": "ATTR_ISPOPULATED", "samNameOverride": "service network status is populated", "failureNameOverride": "service network status is not populated", "conditionalSam": null, "scoringEffect": "Scoring", "scoringWeight": 1, "criticalityIndicator": false, "samParameters": [], "conditionalSamParameters": [] } ] }