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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-8611

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 FTX00008
Data Element Name COST-SETTLEMENT-PAYMENT.MBESCBES-CATEGORY-OF-SERVICE
Validation Logic 'if the MBESCBES-CATEGORY-OF-SERVICE field is populated and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM-GROUP equals '1' and COST-SETTLEMENT-PAYMENT.MBESCBES-FORM equals '64.9BASE', then the value must be contained in the set of valid values with id: '64.9BASE-FORM' and (if COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE is non-null then COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE >= Valid Values Effective-Date and COST-SETTLEMENT-PAYMENT.COST-SETTLEMENT-PERIOD-END-DATE <= Valid Values End-Date)'
Rule Definition If the MBESCBES category of service is populated and MBESCBES form is '64.9BASE' on the Cost Settlement Payment Transaction from a FTX file, then the MBESCBES category of service reported must be found in the list of valid values for '64.9BASE-FORM'.
Denominator Logic # of FTX Cost Settlement Payment Transactions with COST-SETTLEMENT-PAYMENT.MBESCBES-CATEGORY-OF-SERVICE equal to a valid, non-null value and with COST-SETTLEMENT-PAYMENT.MBESCBES-FORM-GROUP is equal to '1' and with COST-SETTLEMENT-PAYMENT.MBESCBES-FORM is equal to '64.9BASE'