EXP-45-005-5

Data Quality Measure

Last updated

No Updates

Key Information

Measure Name	% of MSIS IDs with any enrollment time span
File Type	Multiple Files
Measure ID	EXP-45-005-5
Measure Type	Claims Percentage
Content area	EXP

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	Critical
Focus Area	N/A
Category	File integrity

Claim Information

Claim Type	Medicaid,Supp or CHIP,Supp
Adjustment Type	All Adjustment Types
Crossover Type	All Indicators

Thresholds

Minimum	0.99
Maximum	1
TA Minimun	0.99
TA Maximum	1
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 • MSIS-IDENTIFICATION-NUM
DD Data Element Number	CLT022 • ELG251

Annotation	Calculate the percentage of unique MSIS IDs on Medicaid and S-CHIP Supplemental: Original and Adjustment, Paid LT Claims found on any enrollment time span segment
Specification	STEP 1: Active non-duplicate LT records during DQ report month Define the LT records universe at the header level that satisfy the following criteria: 1. Reporting Period for the filename = DQ report month 2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing 3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing 4. TYPE-OF-CLAIM is not equal to "Z" or is missing 5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing 6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND. STEP 2: Medicaid and S-CHIP Supplemental: Original and Adjustment, Paid Claims Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria: 1. TYPE-OF-CLAIM = "5" or "E" STEP 3: Unique MSIS IDs From the claims in STEP 3, create a list of unique MSIS-IDENTIFICATION-NUM values. STEP 4: Link claims to enrollment time span segment Of the unique MSIS-IDENTIFICATION-NUM values from STEP 3, restrict to those where: 1. MSIS-IDENTIFICATION-NUM is found on an ENROLLMENT-TIME-SPAN-ELG00021 segment STEP 5: Calculate percentage Divide the count of unique MSIS-IDENTIFICATION-NUM values from STEP 4 by the count from STEP 3

Annotation

Calculate the percentage of unique MSIS IDs on Medicaid and S-CHIP Supplemental: Original and Adjustment, Paid LT Claims found on any enrollment time span segment

Specification

STEP 1: Active non-duplicate LT records during DQ report month

Define the LT records universe at the header level that satisfy the following criteria:

1. Reporting Period for the filename = DQ report month

2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing

3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing

4. TYPE-OF-CLAIM is not equal to "Z" or is missing

5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing

6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.

STEP 2: Medicaid and S-CHIP Supplemental: Original and Adjustment, Paid Claims

Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria:

1. TYPE-OF-CLAIM = "5" or "E"

STEP 3: Unique MSIS IDs

From the claims in STEP 3, create a list of unique MSIS-IDENTIFICATION-NUM values.

STEP 4: Link claims to enrollment time span segment

Of the unique MSIS-IDENTIFICATION-NUM values from STEP 3, restrict to those where:

1. MSIS-IDENTIFICATION-NUM is found on an ENROLLMENT-TIME-SPAN-ELG00021 segment

STEP 5: Calculate percentage

Divide the count of unique MSIS-IDENTIFICATION-NUM values from STEP 4 by the count from STEP 3