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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-1116

Validation Rule
Last updated

No Updates

Tier 3.0
Tier Description Relational error
Error Category E3002
Error Category Message Values inconsistently specified (multiple record types, multi file)
Rule Type Three Record Type Rule
File Segment Number ELG00002
Data Element Name PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-BIRTH • CLAIM-HEADER-RECORD-LT.DATE-OF-BIRTH
Validation Logic 'if CLAIM-HEADER-RECORD-LT has a valid, non-null value for DATE-OF-BIRTH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-BIRTH and ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND does not equal '1' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP does not equal '64' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-HEADER-RECORD-LT.DATE-OF-BIRTH equals PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-BIRTH'
Rule Definition If a claim is a non-denied claim from an LT file and the date of birth is populated, and the primary demographics eligibility conception to birth indicator does not equal 'yes' and eligibility determinants eligibility group is not coverage from conception to birth, then the LT claim segment date of birth is equal to the primary demographics eligibility segment date of birth.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.DATE-OF-BIRTH equal to a valid, non-null value and with PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-BIRTH equal to a valid, non-null value and with ELIGIBILITY-DETERMINANTS.CONCEPTION-TO-BIRTH-IND not equal to '1' and with ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP not equal to '64' and with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2',