ELG.002.023

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TMSIS Dataguide

Medicaid.gov

Version:

SEX

Data Element

DE Number

ELG023

System DE Number

ELG.002.023

File Name

File Segment Number

File Segment Name

PRIMARY-DEMOGRAPHICS-ELIGIBILITY

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The individual's biological sex assigned at birth.
Size	X(1)
FLF Start Position	103
FLF Stop Position	103
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Sex List (VVL) 2. Value must be 1 character 4. Mandatory

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-2012	If sex is populated on a primary demographics eligibility segment from an ELG file, then the sex value reported must be in the list of valid values for sex.
RULE-6315	If a segment is a primary demographics eligibility segment from an ELG file, the sex value reported must be compatible with the specified T-MSIS picture format: X(1).

Measure ID	Measure Name
EL-1-019-6	% of MSIS IDs who are female
EL-3-011-10	% of MSIS IDs in ELIGIBILITY-GROUP = 34 (BCCP) that are female
MIS-1-006-6	% distinct MSIS IDs with only missing values in any active segment: SEX (ELG00002)
EL-3-028-37	% of MSIS IDs with PREGNANCY-INDICATOR= 1 that have SEX = “M”
EL-3-029-38	% of MSIS IDs with RESTRICTED-BENEFITS-CODE = "4" that have SEX = “M”
ALL-16-009-9	% of claim lines with TYPE-OF-SERVICE= “086” (IP) linked to an MSIS ID where SEX = “M”
ALL-16-010-10	% of claim lines with TYPE-OF-SERVICE= “086” (RX) linked to an MSIS ID where SEX = “M”
ALL-16-011-11	% of claim lines with TYPE-OF-SERVICE= “025” or “085” (OT) linked to an MSIS ID where SEX = “M”
ALL-16-012-12	% of claim lines with XIX-MBESCBES-CATEGORY-OF-SERVICE = “14”, “35”, “42” or “44” (IP) linked to an MSIS ID where SEX = “M”
ALL-16-013-13	% of claim lines with XIX-MBESCBES-CATEGORY-OF-SERVICE = “14”, “35”, “42” or “44” (LT) linked to an MSIS ID where SEX = “M”
ALL-16-014-14	% of claim lines with XIX-MBESCBES-CATEGORY-OF-SERVICE = “14”, “35”, “42” or “44” (OT) linked to an MSIS ID where SEX = “M”
ALL-16-015-15	% of claim lines with XIX-MBESCBES-CATEGORY-OF-SERVICE = “14”, “35”, “42” or “44” (RX) linked to an MSIS ID where SEX = “M”
RULE-7367	% of segments with missing SEX (ELG00002)
EL-3-034-43	% of MSIS IDs with ELIGIBILITY-GROUP = 05 (Pregnant Women) where SEX is not equal to “M” with Age 40-44

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
PRV031	PRV.002.031	SEX	PRV00002	PROV-ATTRIBUTES-MAIN

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
02/27/2025	3.34.0	ELG.002.023	UPDATE	Coding requirement	1. Value must be in Sex List (VVL)2. Value must be 1 character3. (Pregnancy) if value equals "M", then associated Pregnancy Indicator (ELG.003.049) value must not equal "1"4. Mandatory	1. Value must be in Sex List (VVL)2. Value must be 1 character4. Mandatory
02/20/2025	3.34.0	ELG.002.023	UPDATE	Definition	Either individual's biological sex or their self-identified sex.	The individual's biological sex assigned at birth.
09/12/2024	3.29.0	ELG.002.023	UPDATE	Coding requirement	1. Value must be in Sex List (VVL)2. Value must be 1 character3. (Pregnancy) if value equals "M", then associated Pregnancy Indicator (ELG.003.049) value must not equal '1'4. Mandatory	1. Value must be in Sex List (VVL)2. Value must be 1 character3. (Pregnancy) if value equals "M", then associated Pregnancy Indicator (ELG.003.049) value must not equal "1"4. Mandatory