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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-8411

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 FTX00002
Data Element Name INDIVIDUAL-CAPITATION-PMPM.CATEGORY-FOR-FEDERAL-REIMBURSEMENT
Validation Logic 'If the CATEGORY-FOR-FEDERAL-REIMBURSEMENT field is populated, the value must be contained in the set of valid values with id: 'CATEGORY-FOR-FEDERAL-REIMBURSEMENT' and (if INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE is non-null then INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-CAPITATION-PMPM.CAPITATION-PERIOD-END-DATE <= Valid Values End-Date)'
Rule Definition If the category for federal reimbursement is populated on the Individual Capitation PMPM transaction from a FTX file, then the category for federal reimbursement reported must be found in the list of valid values.
Denominator Logic # of FTX Individual Capitation PMPM transactions with INDIVIDUAL-CAPITATION-PMPM.CATEGORY-FOR-FEDERAL-REIMBURSEMENT equal to a valid, non-null value