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TMSIS Dataguide Medicaid.gov
Version 3.38.0

EL-3-023-28

Data Quality Measure
Last updated

No Updates

Key Information

Measure Name # of distinct mandatory eligibility group values populated for transitional medical assistance (ELIGIBILITY-GROUP = 02 or 03)
File Type ELG
Measure ID EL-3-023-28
Measure Type Count
Content area ELG

Validation

Validation Type Inferential

Measure Priority

Measure Priority High
Focus Area N/A
Category Beneficiary eligibility

Claim Information

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

Thresholds

Minimum 1
Maximum 2
TA Minimun 1
TA Maximum 2
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		TA- Inferential
For TA
(Longitudinal) 		No

Data Elements

DD Data Element ELIGIBILITY-GROUP
DD Data Element Number ELG087

Annotation Count the number of mandatory eligibility groups for traditional medical assistance with at least one MSIS ID with a primarily eligibility group indicator associated with it
Specification STEP 1: Enrolled on the last day of DQ report month

Define the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:

1. ENROLLMENT-EFF-DATE <= last day of the DQ report month

2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing

3. MSIS-IDENTIFICATION-NUM is not missing



STEP 2: Eligibility determinants on the last day of DQ report month

Using the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:

1. PRIMARY-ELIGIBILITY-GROUP-IND = 1

2a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month

3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missing

OR

2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing

3b. ELIGIBILITY-DETERMINANT-END-DATE is missing



STEP 3: Frequency of mandatory eligibility groups

Of the MSIS IDs that meet the criteria from STEP 2, count the number of unique MSIS IDs where ELIGIBILITY-GROUP is equal to each of the following values: 02, 03



STEP 4: Count of categories

Of the 2 mandatory eligibility group categories referenced in STEP 3, count the number of categories with at least one MSIS ID