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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.PAYER-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 PAYER-ID and FQHC-WRAP-PAYMENT.PAYER-ID-TYPE equals '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, PAYER-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 PAYER ID is populated on FQHC Wrap Payment segment from the FTX file and the PAYER ID Type is Capitated plan ID, then the PAYER 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 PAYER-ID and with FQHC-WRAP-PAYMENT.PAYER-ID-TYPE is equal to '02' and with FQHC-WRAP-PAYMENT.ADJUSTMENT-IND does not equal to '1' |