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Tier | 3.0 |
---|---|
Tier Description | Relational error |
Error Category | E3001 |
Error Category Message | Missing corresponding record (2 record types, multi file) (ex. missing eligibility record for claim header) |
Rule Type | Two Record Type (1 to 1) |
File Segment Number | PRV00002 |
Data Element Name | INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.SUBMITTING-STATE • INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PAYEE-ID • PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE • PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE • INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-START-DATE |
Validation Logic | if INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT has a valid, non-null value for PAYEE-ID and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PAYEE-ID-TYPE is equal to one of the following: '04', '05' and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.ADJUSTMENT-IND does not equal '1', then for every record of type INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT, there must be a valid record of type PROV-ATTRIBUTES-MAIN that matches on the join keys(PROV-ATTRIBUTES-MAIN[SUBMITTING-STATE, SUBMITTING-STATE-PROV-ID], INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT[SUBMITTING-STATE, PAYEE-ID]) and INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-START-DATE must be in (PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE, PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE) |
Rule Definition | If a financial transaction is a non-void, and the PAYEE ID is populated on Individual Health Insurance Premium Payment segment from the FTX file and the PAYEE ID type is either Sub-capitated network provider ID or State contracted FFS provider ID assigned by state, then the PAYEE ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the premium period start date on the financial transaction. |
Denominator Logic | # of FTX Individual Health Insurance Premium Payment Transactions with INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT has a valid, non-null value for PAYEE-ID and with INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.PAYEE-ID-TYPE is equal to one of the following: '04', '05' and with INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT.ADJUSTMENT-IND does not equal to '1' |