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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-477

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.DATE-OF-DEATH • CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-5
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2'and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-5, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-5 is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'
Rule Definition If the fifth procedure code date is populated on a non-denied claim from an IP file and the date of death is populated on a primary demographics eligibility segment from an ELG file with the same MSIS ID where the effective date and end date span the firth procedure code date, then the fifth procedure code date value reported must be before or equal to the date of death.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH equal to a valid, non-null AND CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-5 equal to a valid, non-null