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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

EL-3-034-43

Data Quality Measure
Last updated

Key Information

Measure Name % of MSIS IDs with ELIGIBILITY-GROUP = 05 (Pregnant Women) where SEX is not equal to “M” with Age 40-44
File Type ELG
Measure ID EL-3-034-43
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 0.3
TA Minimun 0
TA Maximum 0.3
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 • MSIS-IDENTIFICATION-NUM • ELIGIBILITY-GROUP
DD Data Element Number ELG019 • ELG023 • ELG082 • ELG087

Annotation Calculate the percentage of MSIS IDs with a ELIGIBILITY-GROUP value of "05", where SEX is not "M", that are between the ages of 40 and 44
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: ELIGIBILITY-GROUP = "05"

Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records with ELIGIBILITY-GROUP = "05"



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 is not equal to "M"

Of the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records where SEX is not "M"



STEP 6: Calculate Age

Of the MSIS IDs that meet the criteria from STEP 5, calculate age:

1a. If DATE-OF-DEATH is non-missing and occurs before the last day of the DQ report month, Age is equal to the years between DATE-OF-DEATH and DATE-OF-BIRTH.

1b. Otherwise, Age is equal to the years between the last day of the DQ report month and DATE-OF-BIRTH.



STEP 7: Individuals between the ages of 40 and 44

Refine the MSIS IDs from STEP 6 by keeping records with:

1. Age >= 40 and Age <= 44



STEP 8: Calculate percentage for measure

DIVIDE the count of MSIS IDs from STEP 7 by the count of MSIS IDs from STEP 3