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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-8585

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 FTX00004
Data Element Name GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-CATEGORY-OF-SERVICE
Validation Logic 'if the MBESCBES-CATEGORY-OF-SERVICE field is populated and GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP equals '3' and GROUP-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: '21COS' and (if GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE is non-null then GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-END-DATE >= Valid Values Effective-Date and GROUP-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 Group 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 '21COS'.
Denominator Logic # of FTX Group Insurance Premium Payment Transactions with GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-CATEGORY-OF-SERVICE equal to a valid, non-null value and with GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM-GROUP is equal to '3' and with GROUP-INSURANCE-PREMIUM-PAYMENT.MBESCBES-FORM has non null value