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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-7677

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 ELG00003
Data Element Name VARIABLE-DEMOGRAPHICS-ELIGIBILITY.SUBMITTING-STATE • VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE • VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE • ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE • ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE • FILE-HEADER-RECORD-ELIGIBILITY.END-OF-TIME-PERIOD • VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MEDICARE-BENEFICIARY-IDENTIFIER • VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MEDICARE-HIC-NUM • VARIABLE-DEMOGRAPHICS-ELIGIBILITY.MSIS-IDENTIFICATION-NUM • ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE
Validation Logic if (VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-BENEFICIARY-IDENTIFIER or VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-HIC-NUM) and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-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 VARIABLE-DEMOGRAPHICS-ELIGIBILITY, there must be a valid record of type ELIGIBILITY-DETERMINANTS that matches on the join keys and ELIGIBILITY-DETERMINANTS.DUAL-ELIGIBLE-CODE is equal to one of the following: '01', '02', '03', '04', '05', '06', '08', '09', '10' and (MAX(VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE, 'cutover date') >= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-EFF-DATE and VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE <= ELIGIBILITY-DETERMINANTS.ELIGIBILITY-DETERMINANT-END-DATE)
Rule Definition If a segment is a variable demographic eligibility segment from an ELG file, and the medicare beneficiary identifier or the medicare hic num are populated, and the variable demographic element end date is greater than or equal to the TMSIS cutover date, and the primary eligibility group indicator is '1', then the dual eligible code are equal to one of the following values '01', '02', '03', '04', '05', '06', '08', '09', or '10' and the effective and end dates on the variable demographic eligibility segment fall within the effective and end dates of one or more continuous eligibility determinants segments.
Denominator Logic # of VARIABLE-DEMOGRAPHICS-ELIGIBILITY segments with (VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-BENEFICIARY-IDENTIFIER or VARIABLE-DEMOGRAPHICS-ELIGIBILITY has a non-null value for MEDICARE-HIC-NUM) and with VARIABLE-DEMOGRAPHICS-ELIGIBILITY.VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is greater than or equal to 'cutover date', and with ELIGIBILITY-DETERMINANTS.PRIMARY-ELIGIBILITY-GROUP-IND equals '1'