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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-677

Validation Rule
Last updated

No Updates

Tier 3.0
Tier Description Relational error
Error Category E3002
Error Category Message Values inconsistently specified (multiple record types, multi file)
Rule Type Three Record Type Rule
File Segment Number ELG00002
Data Element Name PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH • CLAIM-HEADER-RECORD-IP.DATE-OF-BIRTH
Validation Logic 'if CLAIM-HEADER-RECORD-IP has a valid, non-null value for DATE-OF-BIRTH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-HEADER-RECORD-IP.DATE-OF-BIRTH is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'
Rule Definition If a non-denied IP claim has a value populated for date of birth and the primary demographics eligibility segment has a value populated for date of death and the claim is not for a conception to birth eligible, then the date of death value is equal to or after the date of birth.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.DATE-OF-BIRTH equal to a valid, non-null value and with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' and with PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH equal to a valid, non-null value and with ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND not equal to '1' and with ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP not equal to '64'