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-8759

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 FQHC-WRAP-PAYMENT.SUBMITTING-STATE • FQHC-WRAP-PAYMENT.PAYEE-ID • MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE • MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE • FQHC-WRAP-PAYMENT.WRAP-PERIOD-START-DATE
Validation Logic if FQHC-WRAP-PAYMENT has a valid, non-null value for PAYEE-ID and FQHC-WRAP-PAYMENT.PAYEE-ID-TYPE is equal to one of the following: '02' and FQHC-WRAP-PAYMENT.ADJUSTMENT-IND does not equal '1', then for every record of type FQHC-WRAP-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], FQHC-WRAP-PAYMENT[SUBMITTING-STATE, PAYEE-ID]) and FQHC-WRAP-PAYMENT.WRAP-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 FQHC Wrap 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 wrap period start date on the financial transaction.
Denominator Logic # of FTX FQHC Wrap Payment Transactions with FQHC-WRAP-PAYMENT has a valid, non-null value for PAYEE-ID and with FQHC-WRAP-PAYMENT.PAYEE-ID-TYPE is equal to '02' and with FQHC-WRAP-PAYMENT.ADJUSTMENT-IND does not equal to '1'