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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-7427

Validation Rule
Last updated

Tier 3.0
Tier Description Relational error
Error Category E3001
Error Category Message Missing corresponding record (2 record types, multi file) (ex. missing eligibility record for claim header)
Rule Type Two Record Type (1 to 1)
File Segment Number ELG00012
Data Element Name WAIVER-PARTICIPATION.SUBMITTING-STATE • ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND • WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE • WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE • ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE • ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE • FILE-HEADER-RECORD-ELIGIBILITY.END-OF-TIME-PERIOD • WAIVER-PARTICIPATION.WAIVER-TYPE • WAIVER-PARTICIPATION.MSIS-IDENTIFICATION-NUM • ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE
Validation Logic if WAIVER-PARTICIPATION.WAIVER-TYPE equals '24', then for every record of type WAIVER-PARTICIPATION, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and (WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-EFF-DATE >= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and WAIVER-PARTICIPATION.WAIVER-ENROLLMENT-END-DATE <= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE), and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.RESTRICTED-BENEFITS-CODE equals '6'
Rule Definition If a segment is a waiver participation segment from an ELG file, and the waiver participation segment has a family planning demonstration waiver type and the effective and end dates on the waiver participation segment fall within the effective and end dates of one or more continuous eligibility determinants segments, and the eligibility determinants has a primary eligibility group indicator equal to '1', then the restricted benefits code is equal to '6'.
Denominator Logic # of WAIVER-PARTICIPATION segments with WAIVER-PARTICIPATION.WAIVER-TYPE is equal to '24'