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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-8576

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 FTX00003
Data Element Name INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-CATEGORY-OF-SERVICE
Validation Logic 'if the MBESCBES-CATEGORY-OF-SERVICE field is populated and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '1' and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT has a non-null value for MBESCBES-FORM, then the value must be contained in the set of valid values with id: '64.9COS' and (if INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE <= Valid Values End-Date)'
Rule Definition If the MBESCBES category of service is populated and MBESCBES form is populated on the Individual Health Insurance Premium Payment Transaction from a FTX file, then the MBESCBES category of service reported must be found in the list of valid values for '64.9COS'.
Denominator Logic # of FTX Individual Health Insurance Premium Payment Transactions with INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-CATEGORY-OF-SERVICE equal to a valid, non-null value and with INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP is equal to '1' and with INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM has non null value