EL-10-003-2

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Measure Name	# of managed care plan enrollees
File Type	ELG
Measure ID	EL-10-003-2
Measure Type	Count
Content area	ELG MCR MULTI

Validation Type	Longitudinal

Measure Priority	Medium
Focus Area	Managed care
Category	Program participation

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

Minimum	N/A
Maximum	N/A
TA Minimun
TA Maximum
Longitudinal Threshold	0.1
For TA (for including in compliance training)	TA- Longitudinal
For TA (Longitudinal)	Yes

DD Data Element	MANAGED-CARE-PLAN-TYPE • MSIS-IDENTIFICATION-NUM
DD Data Element Number	ELG193 • ELG191

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	EL-10-003-2	UPDATE	Annotation	Count the total number of MSIS ID's that are enrolled in at least one managed care plan with a valid plan type	N/A
11/20/2025	4.0.22	EL-10-003-2	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: Managed care enrollment on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Unique Valid ValuesOf the MSIS IDs which meet the criteria from STEP 2, restrict to those with a valid MANAGED-CARE-PLAN-TYPE:1. MANAGED-CARE-PLAN-TYPE = "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14", "15", "16", "17", "18", "19", "20", "60", "70", "80"STEP 4: Count unique MSIS IDsCount the number of unique MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-10-003-2	ADD	N/A		Created

EL-10-003-2

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements