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Measure Name | % of MSIS IDs with any enrollment time span |
---|---|
File Type | Multiple Files |
Measure ID | FFS-24-001-1 |
Measure Type | Claims percentage |
Content area | FFS |
Validation Type | Inferential |
---|
Measure Priority | N/A |
---|---|
Focus Area | N/A |
Category | N/A |
Claim Type | Medicaid,FFS |
---|---|
Adjustment Type | All Adjustment Types |
Crossover Type | All Indicators |
Minimum | 0.99 |
---|---|
Maximum | 1 |
TA Minimun | |
TA Maximum | |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
No |
For TA
(Longitudinal) |
No |
DD Data Element | MSIS-IDENTIFICATION-NUM • MSIS-IDENTIFICATION-NUM |
---|---|
DD Data Element Number | CIP022 • ELG251 |
Annotation | Calculate the percentage of MSIS IDs on Medicaid FFS: original and adjustment, paid IP claims that can be found on any Eligible file enrollment time span segment |
---|---|
Specification |
STEP 1: Active non-duplicate IP records during DQ report month Define the IP records universe at the header level that satisfy the following criteria: 1. Reporting Period for the filename = DQ report month 2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing 3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing 4. TYPE-OF-CLAIM is not equal to "Z" or is missing 5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing 6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND. STEP 2: Medicaid FFS: Original and Adjustment, Paid Claims Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria: 1. TYPE-OF-CLAIM = "1" STEP 3: Unique MSIS-IDs in claims Of the claims that meet the criteria from STEP 2, limit to unique MSIS-IDs STEP 4: Unique MSIS-IDs from Eligible file Identify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segment STEP 5: Link MSIS-IDs across files Count the number of MSIS-IDs from STEP 3 that are also in STEP 4 STEP 6: Calculate percentage Divide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3 |