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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-2384

Validation Rule
Last updated

Tier 3.0
Tier Description Relational error
Error Category E3002
Error Category Message Values inconsistently specified (multiple record types, multi file)
Rule Type Two Record Type (1 to 1)
File Segment Number ELG00014
Data Element Name MANAGED-CARE-PARTICIPATION.SUBMITTING-STATE • MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ID • MANAGED-CARE-MAIN.MANAGED-CARE-PLAN-TYPE • MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE • MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE • MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE • FILE-HEADER-RECORD-ELIGIBILITY.END-OF-TIME-PERIOD • MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE
Validation Logic if MANAGED-CARE-PARTICIPATION has a valid, non-null value for ENROLLED-MANAGED-CARE-PLAN-TYPE and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is greater than or equal to 'cutover date' and MANAGED-CARE-MAIN has a valid, non-null value for MANAGED-CARE-PLAN-TYPE, then for every record of type MANAGED-CARE-PARTICIPATION, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and MANAGED-CARE-PARTICIPATION.ENROLLED-MANAGED-CARE-PLAN-TYPE equals MANAGED-CARE-MAIN.MANAGED-CARE-PLAN-TYPE and (MAX(MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE, null) >= MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE <= MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)
Rule Definition 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.
Denominator Logic # of MANAGED-CARE-PARTICIPATION segments with MANAGED-CARE-PARTICIPATION has a valid, non-null value for ENROLLED-MANAGED-CARE-PLAN-TYPE and with MANAGED-CARE-MAIN has a valid, non-null value for MANAGED-CARE-PLAN-TYPE, and with MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is greater than or equal to 'cutover date'