An official website of the United States government

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.

TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-8741

Validation Rule
Last updated

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 PRV00002
Data Element Name VALUE-BASED-PAYMENT.SUBMITTING-STATE • VALUE-BASED-PAYMENT.PAYER-ID • PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-EFF-DATE • PROV-ATTRIBUTES-MAIN.PROV-ATTRIBUTES-END-DATE • VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-START-DATE
Validation Logic if VALUE-BASED-PAYMENT has a valid, non-null value for PAYER-ID and VALUE-BASED-PAYMENT.PAYER-ID-TYPE is equal to one of the following: '04' and VALUE-BASED-PAYMENT.ADJUSTMENT-IND does not equal '1', then for every record of type VALUE-BASED-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], VALUE-BASED-PAYMENT[SUBMITTING-STATE, PAYER-ID]) and VALUE-BASED-PAYMENT.PERFORMANCE-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 payer ID is populated on Value Based Payment segment from the FTX file and the payer id type is Sub-capitated network provider ID, then the payer 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 performance period start date on the financial transaction.
Denominator Logic # of FTX Value Based Payment Transactions with VALUE-BASED-PAYMENT has a valid, non-null value for PAYER-ID and with VALUE-BASED-PAYMENT.PAYER-ID-TYPE is equal to '04' and with VALUE-BASED-PAYMENT.ADJUSTMENT-IND does not equal to '1'