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-8754

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 MCR00002
Data Element Name GROUP-INSURANCE-PREMIUM-PAYMENT.SUBMITTING-STATE • GROUP-INSURANCE-PREMIUM-PAYMENT.PAYEE-ID • MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE • MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE • GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-START-DATE
Validation Logic if GROUP-INSURANCE-PREMIUM-PAYMENT has a valid, non-null value for PAYEE-ID and GROUP-INSURANCE-PREMIUM-PAYMENT.PAYEE-ID-TYPE is equal to one of the following: '02' and GROUP-INSURANCE-PREMIUM-PAYMENT.ADJUSTMENT-IND does not equal '1', then for every record of type GROUP-INSURANCE-PREMIUM-PAYMENT, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys(MANAGED-CARE-MAIN[SUBMITTING-STATE, STATE-PLAN-ID-NUM], GROUP-INSURANCE-PREMIUM-PAYMENT[SUBMITTING-STATE, PAYEE-ID]) and GROUP-INSURANCE-PREMIUM-PAYMENT.PREMIUM-PERIOD-START-DATE must be in (MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE, MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)
Rule Definition If a financial transaction is a non-void, and the PAYEE ID is populated on Group Insurance Premium Payment segment from the FTX file and the PAYEE ID Type is Capitated plan ID, then the PAYEE ID value reported must be equal to a State Plan Identification Number on a managed care main segment from a MCR file where the managed care contract effective and end dates of the managed care main segment overlap with the premium period start date on the financial transaction.
Denominator Logic # of FTX Group Insurance Premium Payment Transactions with GROUP-INSURANCE-PREMIUM-PAYMENT has a valid, non-null value for PAYEE-ID and with GROUP-INSURANCE-PREMIUM-PAYMENT.PAYEE-ID-TYPE is equal to '02' and with GROUP-INSURANCE-PREMIUM-PAYMENT.ADJUSTMENT-IND does not equal to '1'