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TMSIS Dataguide Medicaid.gov
Version 3.31.0

RULE-2155

Validation Rule
Last updated

No Updates

Tier 2.1
Tier Description Relational error
Error Category E2102
Error Category Message Values inconsistently specified (multi record, single file)
Rule Type Two Record Type (1 to 1)
File Segment Number ELG00002
Data Element Name PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX
Validation Logic 'if ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '4', then PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SEX equals 'F''
Rule Definition If restricted benefits code is for pregnancy-related services only on an eligibility determinants segment from an ELG file, then the sex reported on the corresponding primary demographics eligibility segment must be female.
Denominator Logic # of PRIMARY-DEMOGRAPHICS-ELIGIBILITY segments with PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE and PRIMARY-DEMOGRAPHIC-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE that overlap ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE AND with ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equal to '4'