RULE-2382
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If the managed care plan ID is populated on a managed care participation ELG file segment and the managed care participation managed care plan enrollment end date is greater than the states tmsis cutover date then the effective and end dates on the managed care participation segment must fall within the effective and end dates of one or more continuous managed care main segments.
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RULE-2384
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If the managed care participation plan type is populated on a managed care participation segment and the managed care main plan type is populated on the managed care main file segment and the managed care participation managed care plan enrollment end date is greater than the states tmsis cutover date then managed care participation managed care plan type equals the managed care main managed care plan type and the effective and end dates on the managed care participation segment must fall within the effective and end dates of one or more continuous managed care main segments.
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RULE-2389
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If a segment is a managed care participation segment from an ELG file, then the managed care plan enrollment effective date value reported must be a valid date of the form CCYYMMDD.
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RULE-2391
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If managed care plan enrollment effective date and managed care plan enrollment end date are populated on a managed care participation segment from an ELG file, then the managed care plan enrollment effective date value reported must be before or equal to the managed care plan enrollment end date value reported.
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RULE-7194
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If plan ID is populated on a non-denied, non-void Medicaid, S-CHIP, or Other encounter from an IP file, then the plan ID must be equal to the plan ID on a managed care participation segment from an ELG file with the same MSIS ID and where the admission date on the claim is within the effective and end dates of the managed care participation segment.
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RULE-7195
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If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other encounter from an LT file, then the plan ID must be equal to the plan ID on a managed care participation segment from an ELG file with the same MSIS ID and effective and end dates that overlap the beginning date of service.
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RULE-7196
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If plan ID is populated on a non-denied, non-void Medicaid, S-CHIP, or Other encounter from an OT file, then the plan ID must be equal to the plan ID on a managed care participation segment from an ELG file with the same MSIS ID and enrollment effective and end dates that overlap the beginning date of service.
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RULE-7197
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If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other encounter from an RX file, then the plan ID must be equal to the plan ID on a managed care participation segment from an ELG file with the same MSIS ID and where the prescription fill date on the claim is within the effective and end dates of the managed care participation segment.
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RULE-7706
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If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other capitation from an OT file, then the plan ID must be equal to the plan ID on a managed care participation segment from an ELG file with the same MSIS ID and effective and end dates that overlap the beginning date of service.
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RULE-7709
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If the MSIS ID is populated on a managed care participation ELG file segment and the managed care participation managed care plan enrollment end date is greater than or equal to the states tmsis cutover date then the effective and end dates on the managed care participation segment must fall with the effective and end dates of one or more continuous enrollment time span segments.
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