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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-7408

Validation Rule
Last updated

Tier 2.1
Tier Description Relational error
Error Category E2102
Error Category Message Values inconsistently specified (multi record, single file)
Rule Type Two Record Type (1 to 1)
File Segment Number ELG00014
Data Element Name
Validation Logic 'if MANAGED-CARE-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM and MANAGED-CARE-PARTICIPATION has a non-null and not invalidly formatted value for MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION has a non-null and not invalidly formatted value for MANAGED-CARE-PLAN-ENROLLMENT-END-DATE and ENROLLMENT-TIME-SPAN-SEGMENT has a non-null value for MSIS-IDENTIFICATION-NUM and ENROLLMENT-TIME-SPAN-SEGMENT has a non-null and not invalidly formatted value for ENROLLMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT has a non-null and not invalidly formatted value for ENROLLMENT-END-DATE and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE are overlapping with ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE and MANAGED-CARE-PARTICIPATION has a non-null value for MANAGED-CARE-PLAN-ID, then MANAGED-CARE-PARTICIPATION has a non-null value for ENROLLED-MANAGED-CARE-PLAN-TYPE'
Rule Definition If a segment is a managed care participation segment from an ELG file, and the MSIS ID is populated and the managed care plan ID is populated, and the managed care plan enrollment effective date is less than or equal to the enrollment end date and managed care plan enrollment end date is greater than or equal to the enrollment effective date, then the managed care plan type must be populated.
Denominator Logic # of MANAGED-CARE-PARTICIPATION segments with MANAGED-CARE-PARTICIPATION has a non-null value for MSIS-IDENTIFICATION-NUM and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-SEGMENT has a non-null value for MSIS-IDENTIFICATION-NUM and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE has non-null and not invalidly formatted value and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE has non-null and not invalidly formatted value and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE and MANAGED-CARE-PARTICIPATION.MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE and MANAGED-CARE-PARTICIPATION has a non-null value for MANAGED-CARE-PLAN-ID