Official websites use .gov
A
.gov website belongs to an official government
organization in the United States.
Secure .gov websites use HTTPS
A
lock () or https:// means you've safely connected to
the .gov website. Share sensitive information only on official,
secure websites.
No Updates
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 | PRV00005 |
Data Element Name | COST-SHARING-OFFSET.SUBMITTING-STATE • COST-SHARING-OFFSET.PAYEE-ID • PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE • PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE • PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE • COST-SHARING-OFFSET.COVERAGE-PERIOD-START-DATE |
Validation Logic | if COST-SHARING-OFFSET has a valid, non-null value for PAYEE-ID and COST-SHARING-OFFSET.PAYEE-ID-TYPE equals '06' and COST-SHARING-OFFSET.ADJUSTMENT-IND does not equal '1', then for every record of type COST-SHARING-OFFSET, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys(PROV-IDENTIFIERS[SUBMITTING-STATE, PROV-IDENTIFIER], COST-SHARING-OFFSET[SUBMITTING-STATE, PAYEE-ID]) and COST-SHARING-OFFSET.COVERAGE-PERIOD-START-DATE must be in (PROV-IDENTIFIERS.PROV-IDENTIFIER-EFF-DATE, PROV-IDENTIFIERS.PROV-IDENTIFIER-END-DATE), where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2' |
Rule Definition | If a financial transaction is a non-void, and the PAYEE ID is populated on Cost Sharing Offset segment from the FTX file and the PAYEE ID Type is State contracted FFS provider NPI, then the PAYEE ID value reported must be equal to a provider NPI on a provider identifier segment from a PRV file where the effective and end dates of the provider identifier segment overlap with the coverage period start date on the financial transaction. |
Denominator Logic | # of FTX Cost Sharing Offset Transactions with COST-SHARING-OFFSET has a valid, non-null value for PAYEE-ID and with COST-SHARING-OFFSET.PAYEE-ID-TYPE is equal to '06' and with COST-SHARING-OFFSET.ADJUSTMENT-IND is not equal to '1' |