If your report fails either the Transmittal Validation or Licensing Check, it will be rejected and will not be processed through the remaining edit programs.

Program Description Likely Cause of Failure
Transmittal Validation Checks for proper file format and compares the “Expected” (based on the Transmittal Page information) to “Actual” data submitted. Checks for:
  • Virus infected file
  • No data in file
  • Multiple files in the ZIP file
  • Incorrect file format
  • Discrepancy in the number of records submitted vs. the number entered on the Transmittal screen.
  • One (1) or more records are reported with a Discharge Date that is blank, invalid, or outside the Report Period.
  • Incorrect Facility ID number in any record
  • MIRCal Database errors
Your data did not pass one or more of the transmittal validations.
Licensing Check Checks to make sure your data includes all the types of care and services for which your facility is licensed. For example, if your facility is licensed for Acute care, but no records are reported as Acute type of care, your data will fail this program.

NOTE: This program does not check for records that include a type of care for which your facility is not licensed. The Standard Edit program identifies this type of error.

Your facility is licensed for a specific type of care, but that type of care is not being reported on any of your records.
Trend Edit
(T flag)
Compares the data in the current report period to your facility's historical data to identify uncharacteristic increases or decreases in percentages reported for certain data element categories.

EXAMPLE: In the current report period, your facility reported 65% Non-Hispanic patients, but in the previous two(2) report periods, you reported only 20% Non-Hispanic patients. If this percentage difference between report periods is outside the “Allowable Difference,” either a Critical or Non-Critical Trend flag is generated. Non-Critical flags will not cause your data to fail this program, but one or more Critical flags will.

Your data caused the program to generate one or more Critical Trend flags.
Comparative Edit
(C flag)
Based on the TOTAL records reported, checks for reasonable distribution of categories within each data element for the current report period.

EXAMPLEIf 100% of your records are reported with Patient Disposition–Routine, this program will generate a Comparative Edit flag and your data will fail.

Your data caused the program to generate one or more Comparative Edit flags.
Records with a Blank or Invalid Principal Diagnosis This program identifies records with a Principal Diagnosis that is blank, invalid, reported with an "old" diagnosis code after the effective End Date; or reported with a "new" diagnosis code before the effective Begin Date.  The erroneous Principal Diagnosis code will receive a critical S-flag.
One or more records with a Blank or Invalid Principal Diagnosis.
Standard Edit
(S flag)
Checks for data entry errors and inconsistencies of data reported within each record.

EXAMPLE: Admit Date is AFTER the Discharge Date.
More than 2% of your records contain standard edit errors.
Coding Edit
(V flag)
Checks for illogical combinations of ICD-9-CM codes.

EXAMPLE: It is illogical for a record to have a Principal Diagnosis code for a normal birth and a Procedure code for a C-section.
More than 2% of your records contain coding edit errors.
Re-Admission Edit
(K flag)
Groups records that contain identical Social Security numbers (SSNs), and then checks for inconsistencies between the records.

EXAMPLE: Two records with the same SSN cannot have different Dates of Birth; either the SSN or the Date of Birth is incorrect.

This program also checks for errors in transfers to a different type of care. 

EXAMPLE: A patient is transferred within your hospital from Acute Care to SN/IC on the same day. The Patient Disposition in record 1 is reported as “04 SN/IC within hospital,” but the Source of Admission in record 2 is reported as “132 Home.” This would cause a re-admission error. The Source of Admission in record 2 should be reported as “51x Acute Inpatient within your hospital.”

More than 2% of your records contain re-admission edit errors.

It's important to be able to interpret the error summary and various error reports. Let's take another look at the Main Error Summary page.

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