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-8775

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 MISCELLANEOUS-PAYMENT.SUBMITTING-STATE • MISCELLANEOUS-PAYMENT.PAYEE-ID • PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE • PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE • MISCELLANEOUS-PAYMENT.PAYMENT-PERIOD-START-DATE
Validation Logic if MISCELLANEOUS-PAYMENT has a valid, non-null value for PAYEE-ID and MISCELLANEOUS-PAYMENT.PAYEE-ID-TYPE equals '08' 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 PRIMARY-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys(PRIMARY-DEMOGRAPHICS-ELIGIBILITY[SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM], MISCELLANEOUS-PAYMENT[SUBMITTING-STATE, PAYEE-ID]) and MISCELLANEOUS-PAYMENT.PAYMENT-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 Miscellaneous 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 payment period start date on the financial transaction.
Denominator Logic # of FTX Miscellaneous Payment Transactions with MISCELLANEOUS-PAYMENT has a valid, non-null value for PAYEE-ID and with MISCELLANEOUS-PAYMENT.PAYEE-ID-TYPE is equal to '08' and with MISCELLANEOUS-PAYMENT.ADJUSTMENT-IND does not equal to '1'