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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-8598

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 FTX00006
Data Element Name VALUE-BASED-PAYMENT.MBESCBES-CATEGORY-OF-SERVICE
Validation Logic 'if the MBESCBES-CATEGORY-OF-SERVICE field is populated and VALUE-BASED-PAYMENT.MBESCBES-FORM-GROUP equals '2' and VALUE-BASED-PAYMENT.MBESCBES-FORM equals '64.21U', then the value must be contained in the set of valid values with id: '64.21U-FORM' and (if VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE is non-null then VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE >= Valid Values Effective-Date and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-END-DATE <= Valid Values End-Date)'
Rule Definition If the MBESCBES category of service is populated and MBESCBES form is '64.21U' on the Value Based Payment Transaction from a FTX file, then the MBESCBES category of service reported must be found in the list of valid values for '64.21U-FORM'.
Denominator Logic # of FTX Value Based Payment Transactions with VALUE-BASED-PAYMENT.MBESCBES-CATEGORY-OF-SERVICE equal to a valid, non-null value and with VALUE-BASED-PAYMENT.MBESCBES-FORM-GROUP is equal to '2' and with VALUE-BASED-PAYMENT.MBESCBES-FORM is equal to '64.21U'