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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-3106

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 Two Record Type (1 to 1)
File Segment Number ELG00002
Data Element Name PRIMARY-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE • PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH • TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-END-DATE • PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE • PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE • TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE • FILE-HEADER-RECORD-ELIGIBILITY.END-OF-TIME-PERIOD • PRIMARY-DEMOGRAPHICS-ELIGIBILITY.MSIS-IDENTIFICATION-NUM
Validation Logic if PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null and not invalidly formatted value for DATE-OF-DEATH and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to 'cutover date' and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a non-null value for INSURANCE-COVERAGE-END-DATE, then for every record of type PRIMARY-DEMOGRAPHICS-ELIGIBILITY, there must be a valid record of type TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO that matches on the join keys and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-END-DATE is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH and (MAX(PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE, 'cutover date') >= TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-EFF-DATE and PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE <= TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO.INSURANCE-COVERAGE-END-DATE)
Rule Definition If the date of death is populated on a primary demographics eligibility segment and the primary demographics eligibility primary demographic element end date is greater than the states tmsis cutover date and the insurance coverage end date is populated on the TPL medicaid eligible person health insurance coverage information segment then the TPL medicaid eligible person health insurance coverage info insurance coverage end date is less than or equal to the primary demographics eligibilty date of death and the effective and end dates on the primary demographics eligibility segment must fall with the effective and end dates of one or more continuous TPL medicaid eligible person health insurance coverage information segments.
Denominator Logic # of PRIMARY-DEMOGRAPHICS-ELIGIBILITY segments with PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a non-null and not invalidly formatted value DATE-OF-DEATH and with PRIMARY-DEMOGRAPHICS-ELIGIBILITY.PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to 'cutover date', and with TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO has a non-null value for INSURANCE-COVERAGE-END-DATE