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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-8604

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 FTX00007
Data Element Name STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.MBESCBES-CATEGORY-OF-SERVICE
Validation Logic 'if the MBESCBES-CATEGORY-OF-SERVICE field is populated and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.MBESCBES-FORM-GROUP equals '1' and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM 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 STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE is non-null then STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE >= Valid Values Effective-Date and STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.PAYMENT-PERIOD-END-DATE <= Valid Values End-Date)'
Rule Definition If the MBESCBES category of service is populated and MBESCBES form is populated on the State Directed Payment Separate Payment Term 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 State Directed Payment Separate Payment Term Transactions with STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.MBESCBES-CATEGORY-OF-SERVICE equal to a valid, non-null value and with STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.MBESCBES-FORM-GROUP is equal to '1' and with STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM.MBESCBES-FORM has non null value