EL-6-026-26

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TMSIS Dataguide

Medicaid.gov

Version:

EL-6-026-26

Data Quality Measure

Last updated

Key Information

Measure Name	% of RBC duals (RESTRICTED-BENEFITS-CODE = 3 or G) without a partial dual code (DUAL-ELIGIBLE-CODE not 01, 03, 05, 06)
File Type	ELG
Measure ID	EL-6-026-26
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	DUAL-ELIGIBLE-CODE • RESTRICTED-BENEFITS-CODE
DD Data Element Number	ELG085 • ELG097

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
06/19/2024	3.27.0	EL-6-026-26	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	EL-6-026-26	UPDATE	Category	Beneficiary eligibility	N/A
06/19/2024	3.27.0	EL-6-026-26	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	EL-6-026-26	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	EL-6-026-26	UPDATE	Ta min	0
06/19/2024	3.27.0	EL-6-026-26	UPDATE	Ta max	0.01
06/19/2024	3.27.0	EL-6-026-26	UPDATE	Annotation	Calculate the percentage of RBC dual eligibles who do not have a partial dual code in the dual eligible code element	N/A
06/19/2024	3.27.0	EL-6-026-26	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine 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 missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing 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 = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Restricted benefit dualsOf the MSIS IDs which meet the criteria from STEP 2, restrict to those that are RBC duals:1. RESTRICTED-BENEFITS-CODE = "3" or "G"STEP 4: No partial dual codeOf the MSIS IDs that meet the criteria from STEP 3, further refine the population that satisfy the following criteria:1. DUAL-ELIGIBLE-CODE is not equal to ("01", "03", "05", "06") or is missingSTEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	N/A
09/06/2023	3.12.0	EL-6-026-26	UPDATE	Measure name	% of RBC duals (RESTRICTED-BENEFITS-CODE = 3) without a partial dual code (DUAL-ELIGIBLE-CODE not 01, 03, 05, 06)	% of RBC duals (RESTRICTED-BENEFITS-CODE = 3 or G) without a partial dual code (DUAL-ELIGIBLE-CODE not 01, 03, 05, 06)
09/06/2023	3.12.0	EL-6-026-26	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine 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 missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing 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 = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Restricted benefit dualsOf the MSIS IDs which meet the criteria from STEP 2, restrict to those that are RBC duals:1. RESTRICTED-BENEFITS-CODE = "3"STEP 4: No partial dual codeOf the MSIS IDs that meet the criteria from STEP 3, further refine the population that satisfy the following criteria:1. DUAL-ELIGIBLE-CODE is not equal to ("01", "03", "05", "06") or is missingSTEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3	STEP 1: Enrolled on the last day of DQ report monthDefine 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 missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing 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 = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Restricted benefit dualsOf the MSIS IDs which meet the criteria from STEP 2, restrict to those that are RBC duals:1. RESTRICTED-BENEFITS-CODE = "3" or "G"STEP 4: No partial dual codeOf the MSIS IDs that meet the criteria from STEP 3, further refine the population that satisfy the following criteria:1. DUAL-ELIGIBLE-CODE is not equal to ("01", "03", "05", "06") or is missingSTEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count of unique MSIS IDs from STEP 3