EL-15-011-11

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Measure Name	% difference between T-MSIS Other - specific CMS approval duals and MMA Other - specific CMS approval duals (Dual Code=09)
File Type	ELG
Measure ID	EL-15-011-11
Measure Type	Non-claims percentage
Content area	ELG

Validation Type	Inferential

Measure Priority	Medium
Focus Area	N/A
Category	Beneficiary eligibility

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

Minimum	-0.1
Maximum	0.1
TA Minimun	-0.1
TA Maximum	0.1
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

DD Data Element	MSIS-IDENTIFICATION-NUM • DUAL-ELIGIBLE-CODE
DD Data Element Number	ELG082 • ELG085

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	EL-15-011-11	UPDATE	Annotation	Calculate the percent difference between the T-MSIS Pharm Plus or specials duals count and the MMA Pharm Plus or specials duals count	N/A
11/20/2025	4.0.22	EL-15-011-11	UPDATE	Specification	STEP 1: MMA Pharm Plus or special duals countRetrieve the Pharm Plus or special duals count from the MMA data. This is an external source. More information is available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/DataStatisticalResources/StateMMAFileNote: The MMA count is not always available for the T-MSIS DQ analysis month at the time of the measure calculation. In such cases, the DQ team will wait until the MMA data are ready to do the calculation, so that the MMA count and T-MSIS count are for the same month.STEP 2: Pharm Plus or special duals countUse the measure statistic from EL-6-019-19STEP 3: Difference Subtract the count from STEP 1 from the count of dual eligible beneficiaries from STEP 2STEP 4: PercentageDivide the difference from STEP 3 by the count in STEP 1	N/A
04/24/2025	4.0.7	EL-15-011-11	ADD	N/A		Created

EL-15-011-11

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements