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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

EL-10-007-7

Data Quality Measure
Last updated

Key Information

Measure Name % MSIS IDs with a valid plan type that are missing plan ID
File Type ELG
Measure ID EL-10-007-7
Measure Type Non-Claims Percentage
Content area ELG

Validation

Validation Type Inferential

Measure Priority

Measure Priority N/A
Focus Area N/A
Category N/A

Claim Information

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

Thresholds

Minimum 0
Maximum 0.01
TA Minimun
TA Maximum
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		No
For TA
(Longitudinal) 		No

Data Elements

DD Data Element MSIS-IDENTIFICATION-NUM • MANAGED-CARE-PLAN-TYPE • MANAGED-CARE-PLAN-ID
DD Data Element Number ELG191 • ELG193 • ELG192

Annotation Calculate the percentage of unique MSIS ID's that have a valid managed care plan type and have a missing managed care plan ID
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: Managed care enrollment on the last day of DQ report month

Using the MSIS IDs that meet the criteria from STEP 1, join to segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:

1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month

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

OR

1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing

2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missing



STEP 3: Valid managed care plan type

Of the MSIS IDs which meet the criteria from STEP 2, restrict to those with a valid MANAGED-CARE-PLAN-TYPE:

1. MANAGED-CARE-PLAN-TYPE = “01” – “20” or “60” or “70” or “80”



STEP 4: Missing Plan ID

Of the MSIS IDs which meet the criteria from STEP 3, restrict to those with a missing plan ID

1. MANAGED-CARE-PLAN-ID is missing



STEP 5: Percentage

Divide the count of unique MSIS IDs from STEP 4 by the count in STEP 3