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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-7641

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 ELG00005
Data Element Name ELIGIBILITY-DETERMINANTS.SUBMITTING-STATE • VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MEDICARE-HIC-NUM • VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MEDICARE-BENEFICIARY-IDENTIFIER • ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE • ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE • VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE • VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE • FILE-HEADER-RECORD-ELIGIBILITY.END-OF-TIME-PERIOD • ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND • ELIGIBILITY-DETERMINANTS.MSIS-IDENTIFICATION-NUM • ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE
Validation Logic if ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10' and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to 'cutover date' and ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1', then for every record of type ELIGIBILITY-DETERMINANTS, there must be a valid record of type VARIABLE-DEMOGRAPHICS-ELIGIBILITY that matches on the join keys and (MAX(ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE, 'cutover date') >= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE and ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE <= VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE), and (VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-HIC-NUM or VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-BENEFICIARY-IDENTIFIER)
Rule Definition If a segment is an eligibility determinants segment from an ELG file, and the dual eligible code is '01', '02', '03', '04', '05', '06', '08', '09', or '10', and the eligibility determinants end date is greater than or equal to the TMSIS cutover date, and the primary eligibility group indicator is '1', then the MBI or the Medicare Hic number are populated and the effective and end dates on the eligibility determinants segment fall within the effective and end dates of one or more continuous variable demographic segments.
Denominator Logic # of ELIGIBILITY-DETERMINANTS segments with ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10' and with ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE is greater than or equal to 'cutover date', and with ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1'