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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-8751

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 MISCELLANEOUS-PAYMENT.SUBMITTING-STATE • MISCELLANEOUS-PAYMENT.MSIS-IDENTIFICATION-NUM • ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE • ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE • MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-START-DATE
Validation Logic if MISCELLANEOUS-PAYMENT has a valid, non-null value for MSIS-IDENTIFICATION-NUM 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 ENROLLMENT-TIME-SPAN-SEGMENT that matches on the join keys(ENROLLMENT-TIME-SPAN-SEGMENT[SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM], MISCELLANEOUS-PAYMENT[SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM]) and MISCELLANEOUS-PAYMENT.PAYMENT-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 Miscellaneous Payment 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 Miscellaneous Payment Transactions with MISCELLANEOUS-PAYMENT has a valid, non-null value for MSIS-ID and with MISCELLANEOUS-PAYMENT.ADJUSTMENT-IND does not equal to '1'