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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

EL-3-013-18

Data Quality Measure
Last updated

No Updates

Key Information

Measure Name % of Medicaid MSIS IDs with a CHIP Eligibility Group
File Type ELG
Measure ID EL-3-013-18
Measure Type Non-Claims Percentage
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 0
Maximum 0.01
TA Minimun 0
TA Maximum 0.01
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 • CHIP-CODE • ELIGIBILITY-GROUP
DD Data Element Number ELG033 • ELG054 • ELG087

Annotation Calculate the percentage of unique MSIS IDs classified as Medicaid with an 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: Variable demographics on the last day of DQ report month

Using the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:

1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month

2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missing

OR

1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing

2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missing



STEP 3: Medicaid enrollees

Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:

1. CHIP-CODE="1"



STEP 4: Eligibility determinants on the last day of DQ report month

Using the MSIS IDs that meet the criteria from STEP 3, 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 5: CHIP eligibility group

Of the MSIS IDs that meet the criteria from STEP 3, keep the MSIS IDs that satisfy the following criteria:

1. ELIGIBILITY-GROUP = ("61", "62", "63, "64", "65", "66", "67", or "68")



STEP 6: Percentage

Divide the count of unique MSIS IDs from STEP 5 by the count in STEP 3