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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-2990

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 PRV00009
Data Element Name PROV-AFFILIATED-PROGRAMS.SUBMITTING-STATE • PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-EFF-DATE • PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-END-DATE • MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE • FILE-HEADER-RECORD-PROVIDER.END-OF-TIME-PERIOD • PROV-AFFILIATED-PROGRAMS.AFFILIATED-PROGRAM-TYPE • PROV-AFFILIATED-PROGRAMS.AFFILIATED-PROGRAM-ID • MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE
Validation Logic if PROV-AFFILIATED-PROGRAMS.AFFILIATED-PROGRAM-TYPE equals '2' and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-END-DATE is greater than or equal to 'cutover date', then for every record of type PROV-AFFILIATED-PROGRAMS, there must be a valid record of type MANAGED-CARE-MAIN that matches on the join keys and (MAX(PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-EFF-DATE, 'cutover date') >= MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-EFF-DATE and PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-END-DATE <= MANAGED-CARE-MAIN.MANAGED-CARE-CONTRACT-END-DATE)
Rule Definition If the affiliated program type is equal to '2' (health plan (state assigned health plan ID)) on a provider affiliated programs PRV file segment and the provider affiliated programs prov affiliated program end date is greater than the states tmsis cutover date then the effective and end dates on the provider affiliated programs segment must fall with the effective and end dates of one or more continuous mangaged care main segments.
Denominator Logic # of PROV-AFFILIATED-PROGRAMS segments with PROV-AFFILIATED-PROGRAMS.AFFILIATED-PROGRAM-TYPE equals '2', and with PROV-AFFILIATED-PROGRAMS.PROV-AFFILIATED-PROGRAM-END-DATE is greater than or equal to 'cutover date'