ELG.021.253

ENROLLMENT-EFF-DATE

Data Element

DE Number

ELG253

System DE Number

ELG.021.253

File Name

ELG - ELIGIBLE

File Segment Number

ELG00021

File Segment Name

ENROLLMENT-TIME-SPAN-SEGMENT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The first calendar day on which all of the other data elements in the same segment were effective.
Size	9(8)
FLF Start Position	43
FLF Stop Position	50
Segment Key Field Identifier	(a)
Coding Requirements	1. The date must be a valid calendar date in the form "CCYYMMDD" 2. Value must be on or before the associated Segment End Date value 3. Mandatory 4. Value of the CC component must be in [18,19,20]

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-2017	If conception-to-birth indicator is not for conception-to-birth coverage on a variable demographic segment from an ELG file and the eligibility group is not for conception-to-birth coverage on a corresponding eligiblity determinants segment from an ELG file, then the date of birth on the primary demographics segment must be less than or equal to 125 years before the effective date on any enrollment time span segment with the same MSIS ID.
RULE-2515	If a segment is an enrollment time span segment from an ELG file, then the enrollment effective date value reported must be a valid date of the form CCYYMMDD.
RULE-2517	If enrollment effective date and enrollment end date are populated on an enrollment time span segment from an ELG file, then the enrollment effective date value reported must be before or equal to the enrollment end date value reported.
RULE-7191	If enrollment type is for Medicaid or Medicaid expansion CHIP on an enrollment time span segment from an ELG file, then the effective date and end date on the enrollment time span segment must fall within the effective and end dates of one or more continuous variable demographics eligibility segments and the CHIP code must be for Medicaid or Medicaid expansion CHIP on the variable demographic eligibility segment.
RULE-7192	If enrollment type is for S-CHIP on an enrollment time span segment from an ELG file, then the effective date and end date on the enrollment time span segment must fall within the effective and end dates of one or more continuous variable demographics eligibility segments and the CHIP code must be for S-CHIP on the variable demographic eligibility segment.
RULE-7538	If MSIS ID is populated on an enrollment time span segment from an ELG file, then the effective date and end date on the enrollment time span segment must fall within the effective and end dates of one or more continuous primary demographics eligibility segments and the MSIS ID is populated in the primary demographics eligibility segment.
RULE-7539	If MSIS ID is populated on an enrollment time span segment from an ELG file, then the effective date and end date on the enrollment time span segment must fall within the effective and end dates of one or more continuous variable demographics eligibility segments and the MSIS ID is populated in the variable demographics eligibility segment.
RULE-7540	If MSIS ID is populated on an enrollment time span segment from an ELG file, then the effective date and end date on the enrollment time span segment must fall within the effective and end dates of one or more continuous eligibility determinants segments and the MSIS ID is populated in the eligibility determinants segment.
RULE-7709	If the MSIS ID is populated on a managed care participation ELG file segment and the managed care participation managed care plan enrollment end date is greater than or equal to the states tmsis cutover date then the effective and end dates on the managed care participation segment must fall with the effective and end dates of one or more continuous enrollment time span segments.
RULE-8746	If a financial transaction is a non-void, and the MSIS ID is populated on Individual Capitation Payment segment, then the MSIS ID value reported must be equal to a MSIS ID on a enrollment time span segment from a ELG file where the effective and end dates of the enrollment time span segment overlap with the capitation period start date on the financial transaction.
RULE-8747	If a financial transaction is a non-void, and the MSIS ID is populated on Individual Health Insurance Premium Payment segment, then the MSIS ID value reported must be equal to a submitting state MSIS ID on a enrollment time span segment from a ELG file where the effective and end dates of the enrollment time span segment overlap with the premium period start date on the financial transaction.
RULE-8748	If a financial transaction is a non-void, and the MSIS ID is populated on Group Insurance Premium Payment segment, then the MSIS ID value reported must be equal to a submitting state MSIS ID on a enrollment time span segment from a ELG file where the effective and end dates of the enrollment time span segment overlap with the premium period start date on the financial transaction.
RULE-8749	If a financial transaction is a non-void, and the MSIS ID is populated on Cost Sharing Offset segment,then the MSIS ID value reported must be equal to a MSIS ID on a enrollment time span segment from a ELG file where the effective and end dates of the enrollment time span segment overlap with the premium period start date on the financial transaction.
RULE-8750	If a financial transaction is a non-void, and the MSIS ID is populated on Value Based Payment segment,then the MSIS ID value reported must be equal to a MSIS ID on a enrollment time span segment from a ELG file where the effective and end dates of the enrollment time span segment overlap with the premium period start date on the financial transaction.
RULE-8751	If a financial transaction is a non-void, and the MSIS ID is populated on Miscellaneous Payment segment,then the MSIS ID value reported must be equal to a MSIS ID on a enrollment time span segment from a ELG file where the effective and end dates of the enrollment time span segment overlap with the premium period start date on the financial transaction.

Measure ID	Measure Name
RULE-7645	% of claim headers with an MSIS ID not enrolled on Prescription Fill Date
RULE-1337	% of claim headers with an MSIS ID not enrolled on Beginning Date of Service
RULE-2519	Ratio of errors for overlapping segment eff/end dates [RULE-2519] to all active ENROLLMENT-TIME-SPAN-SEGMENT (ELG00021) segments
RULE-1758	% of claim headers with an MSIS ID not enrolled on Prescription Fill Date
RULE-335	% of claim headers with an MSIS ID not enrolled on Admission Date
RULE-884	% of claim headers with an MSIS ID not enrolled on Beginning Date of Service
EL-19-001-1	% of MSIS IDs enrolled any day in the previous month but not any day in the current month, with missing, invalid, unknown, or other ELIGIBILITY-TERMINATION-REASON
RULE-7642	% of claim headers with an MSIS ID not enrolled on Admission Date
RULE-7643	% of claim headers with an MSIS ID not enrolled on Beginning Date of Service
RULE-7644	% of claim headers with an MSIS ID not enrolled on Beginning Date of Service
EL-14-019-19	Ratio of errors for overlapping segment eff/end dates [RULE-2519] to all active ENROLLMENT-TIME-SPAN-SEGMENT (ELG00021) segments across all reporting and coverage periods
RULE-7646	% of claim headers with an MSIS ID not enrolled on Beginning Date of Service
EL-6-040-40	% of MSIS IDs enrolled in the past year with at least one gap in enrollment over that time
EL-6-041-41	% of MSIS IDs enrolled in the past year with at least three gaps in enrollment over that time
MCR-31-003_3-11	% of MSIS IDs enrolled on Capitation Period Start Date
MCR-31-003_3-12	% of MSIS IDs enrolled on Premium Period Start Date
MCR-31-003_3-13	% of MSIS IDs enrolled on Coverage Period Start Date
MCR-31-008_8-14	% of MSIS IDs enrolled on Capitation Period Start Date
MCR-31-008_8-15	% of MSIS IDs enrolled on Premium Period Start Date
MCR-31-008_8-16	% of MSIS IDs enrolled on Coverage Period Start Date
MCR-31-003-3	% of MSIS IDs enrolled on Beginning Date of Service
FFS-25-002-2	% of MSIS IDs enrolled on Beginning Date of Service
FFS-25-003-3	% of MSIS IDs enrolled on Beginning Date of Service
FFS-25-004-4	% of MSIS IDs enrolled on Prescription Fill Date
FFS-25-005-5	% of MSIS IDs enrolled on Admission Date
FFS-25-006-6	% of MSIS IDs enrolled on Beginning Date of Service
FFS-25-007-7	% of MSIS IDs enrolled on Beginning Date of Service
FFS-25-008-8	% of MSIS IDs enrolled on Prescription Fill Date
MCR-31-001-1	% of MSIS IDs enrolled on Admission Date
MCR-31-002-2	% of MSIS IDs enrolled on Beginning Date of Service
FFS-25-001-1	% of MSIS IDs enrolled on Admission Date
MCR-31-004-4	% of MSIS IDs enrolled on Beginning Date of Service
MCR-31-005-5	% of MSIS IDs enrolled on Prescription Fill Date
MCR-31-006-6	% of MSIS IDs enrolled on Admission Date
MCR-31-007-7	% of MSIS IDs enrolled on Beginning Date of Service
MCR-31-008-8	% of MSIS IDs enrolled on Beginning Date of Service
MCR-31-009-9	% of MSIS IDs enrolled on Beginning Date of Service
MCR-31-010-10	% of MSIS IDs enrolled on Prescription Fill Date
MIS-1-090-90	% distinct MSIS IDs with only missing values in any active segment: ENROLLMENT-EFF-DATE (ELG00021)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
12/19/2024	4.0.1	ELG.021.253	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]
09/16/2024	4.0.0	ELG.021.253	UPDATE	File segment	None	63
09/16/2024	4.0.0	ELG.021.253	ADD	N/A		Created