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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-7768

Validation Rule
Last updated

Tier 2.0
Tier Description Relational error
Error Category E2001
Error Category Message Values inconsistently specified (single record type, single record)
Rule Type One Record Type (Single Record)
File Segment Number ELG00005
Data Element Name ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE
Validation Logic 'if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals 'G', then ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '03', '06''
Rule Definition If the restricted benefits code is equal to 'G' (Medicare Part B-ID ESRD Benefit) on an eligibility determinants segment from an ELG file, then the value for dual eligible code must be one of the following: '01', '03', '06'.
Denominator Logic # of ELIGIBILITY-DETERMINANTS segments with ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equal to 'G'