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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

EL-3-029-38

Data Quality Measure
Last updated

Key Information

Measure Name % of MSIS IDs with RESTRICTED-BENEFITS-CODE = "4" that have SEX = “M”
File Type ELG
Measure ID EL-3-029-38
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 0.05
TA Minimun 0
TA Maximum 0.05
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 • SEX • RESTRICTED-BENEFITS-CODE
DD Data Element Number ELG082 • ELG023 • ELG097

Annotation Calculate the percentage of MSIS IDs with a RESTRICTED-BENEFITS-CODE value of "4" that have a SEX value of “M”
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: RESTRICTED-BENEFITS-CODE = "4"

Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with RESTRICTED-BENEFITS-CODE = "4"



STEP 4: Primary demographics on the last day of DQ report month

Using the MSIS IDs that meet the criteria from STEP 3, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:

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

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

OR

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

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



STEP 5: SEX = "M"

Of the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with with SEX = "M"



STEP 6: Calculate percentage for measure

DIVIDE the count of MSIS IDs from STEP 5 by the count of MSIS IDs from STEP 3