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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

MCR-54-012-12

Data Quality Measure
Last updated

No Updates

Key Information

Measure Name # of PCCM plans with at least 100 enrollments, capitations, or encounters, that do not have a managed care record
File Type Multiple Files
Measure ID MCR-54-012-12
Measure Type Count
Content area MCR

Validation

Validation Type Inferential

Measure Priority

Measure Priority Medium
Focus Area Managed care
Category Managed care file

Claim Information

Claim Type N/A
Adjustment Type N/A
Crossover Type N/A

Thresholds

Minimum 0
Maximum 0
TA Minimun 0
TA Maximum 0
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		TA- Inferential
For TA
(Longitudinal) 		No

Data Elements

DD Data Element TYPE-OF-SERVICE
DD Data Element Number COT186

Annotation Count plan ids in the EL-8-002-2 table with plan type equal to 02 and with at least 100 enrollments, 100 capitations, or 100 encounters that do not link to a plan id on the managed care file
Specification STEP 1: Traditional PCCM

Of the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:

1. Plan_Type_El = "02"



STEP 2: Enrollment, capitation, or encounters

Of the Plan_Ids that meet the criteria in STEP 1, further refine them by keeping those that satisfy the following criteria:

1a. Enrollment >= 100

OR

1b. Total_Capitation > 100

OR

1c. Total_Encounters >= 100



STEP 3: Do not link to managed care file

Of the Plan_Ids that meet the criteria in STEP 1, count the non-missing Plan_Ids where:

1. In_MCR_File = "No"