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TMSIS Dataguide Medicaid.gov
Version 3.36.0

RULE-7555

Validation Rule
Last updated

12/17/2021

Tier 2.0
Tier Description Relational error
Error Category E2001
Error Category Message Values inconsistently specified (single record type, single record)
Rule Type One Record Type (Single Record)
File Segment Number ELG00005
Data Element Name ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP
Validation Logic 'if ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1' and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE equals '03' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01', then ELIGIBILITY-DETERMINANTS.ELIGIBILITY-GROUP equals '25''
Rule Definition If a segment is an eligibility determinants segment from an ELG file, and the MSIS ID is populated, and the primary eligibility group indicator is '1' and the dual eligible code is for SLMB-only ('03'), and the eligibility determinants end date is greater than or equal to '2015-01-01', then the eligibility group is equal to '25'.
Denominator Logic # of ELIGIBILITY-DETERMINANTS segments with ELIGIBILITY-DETERMINANTS has a non-null value for MSIS-IDENTIFICATION-NUM and with ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND is equal to '1' and with ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to '03' and with ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to '2015-01-01'