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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-7420

Validation Rule
Last updated

Tier 2.0
Tier Description Relational error
Error Category E2002
Error Category Message Values inconsistently specified (single record type, multiple records)
Rule Type Two Record Type (1 to 1)
File Segment Number ELG00005
Data Element Name ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE
Validation Logic 'if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS has a non-null and not invalidly formatted value for ELIGIBILITY-DETERMINANT-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 ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE are overlapping with ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE and ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '3' and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1', then ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '03', '05', '06''
Rule Definition If a segment is an eligibility determinants segment from an ELG file, and the MSIS ID is populated and the restricted benefits code is equal to '3' and the primary eligibility group indicator is equal to '1', and the eligibility determinant effective and end dates overlap with the reported enrollment effective and end dates, then the dual eligible code is equal to one of the following values: '01', '03', '05', '06'.
Denominator Logic # of ELIGIBILITY-DETERMINANTS segments with ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and with ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE has non-null and not invalidly formatted value and with ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-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 ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE is less than or equal to ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-END-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to ENROLLMENT-TIME-SPAN-SEGMENT.ENROLLMENT-EFF-DATE AND with ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE is equal to '3' AND with ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1'