Key Information

Measure Name	% difference between full-benefit T-MSIS enrollment count (EL-6-023-23) and PI enrollment count (Medicaid + CHIP)
File Type	ELG
Measure ID	EL-15-001-1
Measure Type	Non-claims percentage
Content area	ELG

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	High
Focus Area	Enrollment monitoring
Category	Beneficiary eligibility

Claim Information

Claim Type	N/A
Adjustment Type	N/A
Crossover Type	N/A

Thresholds

Minimum	-0.05
Maximum	0.05
TA Minimun	-0.05
TA Maximum	0.05
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	MSIS-IDENTIFICATION-NUM • RESTRICTED-BENEFITS-CODE
DD Data Element Number	ELG082 • ELG097

Annotation

Calculate the percent difference between the number of T-MSIS full-benefit enrollees and the Performance Indicator (PI) enrollment count

Specification

STEP 1: Performance indicator enrollment count Retrieve the total PI enrollment count (Medicaid + CHIP) from the PI data. This is an external source. More information is available at: https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-data/monthly-medicaid-chip-application-eligibility-determination-and-enrollment-reports-data/index.html Note: The PI enrollment count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the PI data are ready to do the calculation, so that the PI count and T-MSIS count are for the same month. STEP 2: Full-benefit enrollee count Use the measure statistic from EL-6-023-23 STEP 3: Difference Subtract the count of total PI enrollment from STEP 1 from the count of full-benefit enrollees from STEP 2 STEP 4: Percentage Divide the difference from STEP 3 by the count in STEP 1