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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-8794

Validation Rule
Last updated

No Updates

Tier 2.0
Tier Description Relational error
Error Category E2001
Error Category Message Values inconsistently specified (single record type, single record)
Rule Type One Record Type (Single Record)
File Segment Number FTX00002
Data Element Name INDIVIDUAL-CAPITATION-PMPM.PAYER-ID • INDIVIDUAL-CAPITATION-PMPM.SUBMITTING-STATE
Validation Logic 'if INDIVIDUAL-CAPITATION-PMPM has a valid, non-null value for PAYER-ID and INDIVIDUAL-CAPITATION-PMPM.PAYER-ID-TYPE equals '01' and INDIVIDUAL-CAPITATION-PMPM.ADJUSTMENT-IND does not equal '1', then INDIVIDUAL-CAPITATION-PMPM.PAYER-ID equals INDIVIDUAL-CAPITATION-PMPM.SUBMITTING-STATE'
Rule Definition If a financial transaction is a non-void, and the PAYER ID is populated on Individual Capitation Payment segment from the FTX file and the PAYER ID Type is State, then the PAYER ID value reported must be equal to the value populated for submitting state.
Denominator Logic # of FTX Individual Capitation Payment Transactions with INDIVIDUAL-CAPITATION-PMPM has a valid, non-null value for PAYER-ID and with INDIVIDUAL-CAPITATION-PMPM.PAYER-ID-TYPE is equal to '01' and with INDIVIDUAL-CAPITATION-PMPM.ADJUSTMENT-IND does not equal to '1'