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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

RULE-3123

Validation Rule
Last updated

No Updates

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 TPL00004
Data Element Name TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.COVERAGE-TYPE
Validation Logic 'If the COVERAGE-TYPE field is populated, the value must be contained in the set of valid values with id: 'COVERAGE-TYPE' and (if TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE is non-null then TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE >= Valid Values Effective-Date and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.INSURANCE-CATEGORIES-EFF-DATE <= Valid Values End-Date)'
Rule Definition If the coverage type is populated on a TPL medicaid eligible person health insurance coverage information file, then the coverage type reported must be found in the list of valid values.
Denominator Logic # of TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES segments with TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES.COVERAGE-TYPE equal to a valid, non-null value