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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

RULE-8745

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 MISCELLANEOUS-PAYMENT.SUBMITTING-STATE • MISCELLANEOUS-PAYMENT.PAYER-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 PAYER-ID and MISCELLANEOUS-PAYMENT.PAYER-ID-TYPE is equal to one of the following: '04' 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, PAYER-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 payer ID is populated on Miscellaneous 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 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 PAYER-ID and with MISCELLANEOUS-PAYMENT.PAYER-ID-TYPE is equal to '04' and with MISCELLANEOUS-PAYMENT.ADJUSTMENT-IND does not equal to '1'