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Data Element
ELG097
ELG.005.097
Definition | A flag that indicates the scope of Medicaid or CHIP benefits to which an individual is entitled to. |
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Size | X(1) |
FLF Start Position | 79 |
FLF Stop Position | 79 |
Segment Key Field Identifier | Not Applicable |
Coding Requirements | 1. Value must be 1 character 2. Value must be in Restricted Benefits Code List (VVL) 3. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "05", then Eligibility Group (ELG.005.087) must be "24" 4. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "06", then Eligibility Group (ELG.005.087) must be "26" 5. (Restricted Benefits) if value equals "1" and Dual Eligible Code (ELG.005.085) value equals "02", then Eligibility Group (ELG.005.087) must be "23" 6. (Restricted Benefits) if value equals "1" and Dual Eligible Code (ELG.005.085) value equals "04", then Eligibility Group (ELG.005.087) must be "25" 7. (Restricted Benefits) if value equals "3", then Dual Eligible Code (ELG.005.085) cannot be "00" 8. Mandatory 9. If value is "6" then Eligibility Group(ELG.DE.087) must be in [35,70] 10. If value is in [1,7] then Eligibility Group (ELG.DE.087) must be in [72,73,74,75] and State Plan Option Type (ELG.DE.163) must equal "06" 11. (Restricted Pregnancy-Related) if value equals "4", then associated Sex (ELG.002.023) value must be "F" 12. (Non-Citizen) if value equals "2", then associated Citizenship Indicator (ELG.003.040) value must not be equal to "1" 13. If value is "D", there must be a corresponding MFP enrollment segment (ELG00010) with Effective and End dates that are within the timespan of this segment 14. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "01", then Eligibility Group (ELG.005.087) must be "23" 15. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "03", then Eligibility Group (ELG.005.087) must be "25" 16. (Restricted Benefits) if value is "G", then Dual Eligible Code (ELG.005.085) must be in [01,03,06] |
Valid Value Code Set | Valid Value Code | Valid Value Name | Valid Value Description | Effective Start Date | Effective End Date |
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DE Number | System DE Number | DE Name | File Segment Number | File Segment Name |
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