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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-8771

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 ELG00002
Data Element Name VALUE-BASED-PAYMENT.SUBMITTING-STATE • VALUE-BASED-PAYMENT.PAYEE-ID • PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE • PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE • VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-START-DATE
Validation Logic if VALUE-BASED-PAYMENT has a valid, non-null value for PAYEE-ID and VALUE-BASED-PAYMENT.PAYEE-ID-TYPE equals '08' and VALUE-BASED-PAYMENT.ADJUSTMENT-IND does not equal '1', then for every record of type VALUE-BASED-PAYMENT, there must be a valid record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys(PRIMARY-DEMOGRAPHICS-ELIGIBILITY[SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM], VALUE-BASED-PAYMENT[SUBMITTING-STATE, PAYEE-ID]) and VALUE-BASED-PAYMENT.PERFORMANCE-PERIOD-START-DATE must be in (PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE, PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE)
Rule Definition If a financial transaction is a non-void, and the PAYEE ID is populated on Value Based Payment segment from the FTX file and the PAYEE ID Type is Beneficiary, then the PAYEE ID value reported must be equal to a MSIS Identification Number on a primary demographics eligibility segment from a ELG file where the primary demographic element effective and end dates of the primary demographics eligibility segment overlap with the performance period start date on the financial transaction.
Denominator Logic # of FTX Value Based Payment Transactions with VALUE-BASED-PAYMENT has a valid, non-null value for PAYEE-ID and with VALUE-BASED-PAYMENT.PAYEE-ID-TYPE is equal to '08' and with VALUE-BASED-PAYMENT.ADJUSTMENT-IND does not equal to '1'