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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

RULE-8749

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 ELG00021
Data Element Name COST-SHARING-OFFSET.SUBMITTING-STATE • COST-SHARING-OFFSET.MSIS-IDENTIFICATION-NUM • ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE • ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE • COST-SHARING-OFFSET.COVERAGE-PERIOD-START-DATE
Validation Logic if COST-SHARING-OFFSET has a valid, non-null value for MSIS-IDENTIFICATION-NUM 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 ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(ENROLLMENT-TIME-SPAN-SEGMENT[SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM], COST-SHARING-OFFSET[SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM]) and COST-SHARING-OFFSET.COVERAGE-PERIOD-START-DATE must be in (ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE, ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE)
Rule Definition If a financial transaction is a non-void, and the MSIS ID is populated on Cost Sharing Offset segment,then the MSIS ID value reported must be equal to a MSIS ID on a enrollment time span segment from a ELG file where the effective and end dates of the enrollment time span segment overlap with the premium 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 MSIS-ID and with COST-SHARING-OFFSET.ADJUSTMENT-IND does not equal to '1'