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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-2385

Validation Rule
Last updated

Tier 1.1
Tier Description Value Error
Error Category E1103
Error Category Message Value not in specified valid value set
Rule Type Valid Value
File Segment Number ELG00014
Data Element Name
Validation Logic 'If the ENROLLED-MANAGED-CARE-PLAN-TYPE field is populated, the value must be contained in the set of valid values with id: 'MANAGED-CARE-PLAN-TYPE' and (if MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is non-null then MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE >= Valid Values Effective-Date and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= Valid Values End-Date)'
Rule Definition If managed care plan type is populated on a managed care participation segment from an ELG file, then the managed care plan type value reported must be in the list of valid values for managed care plan type.
Denominator Logic # of MANAGED-CARE-PARTICIPATION segments with MANAGED-CARE-PARTICIPATION.ENROLLED-MANAGED-CARE-PLAN-TYPE equal to a valid, non-null value