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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 | MISCELLANEOUS-PAYMENT.SUBMITTING-STATE • MISCELLANEOUS-PAYMENT.PAYEE-ID • PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE • PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE • MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-START-DATE |
Validation Logic | if MISCELLANEOUS-PAYMENT has a valid, non-null value for PAYEE-ID and MISCELLANEOUS-PAYMENT.PAYEE-ID-TYPE is equal to one of the following: '04', '05' and MISCELLANEOUS-PAYMENT.ADJUSTMENT-IND does not equal '1', then for every record of type MISCELLANEOUS-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], MISCELLANEOUS-PAYMENT[SUBMITTING-STATE, PAYEE-ID]) and MISCELLANEOUS-PAYMENT.PAYMENT-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 Miscellaneous 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 payment period start date on the financial transaction. |
Denominator Logic | # of FTX Miscellaneous Payment Transactions with MISCELLANEOUS-PAYMENT has a valid, non-null value for PAYEE-ID and with MISCELLANEOUS-PAYMENT.PAYEE-ID-TYPE is equal to one of the following: '04', '05' and with MISCELLANEOUS-PAYMENT.ADJUSTMENT-IND does not equal to '1' |