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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

EL-19-001-1

Data Quality Measure
Last updated

Key Information

Measure Name % 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
File Type ELG
Measure ID EL-19-001-1
Measure Type Non-claims percentage
Content area ELG

Validation

Validation Type Inferential

Measure Priority

Measure Priority High
Focus Area N/A
Category Beneficiary eligibility

Claim Information

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

Thresholds

Minimum 0
Maximum 0.5
TA Minimun 0
TA Maximum 0.5
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		TA- Inferential
For TA
(Longitudinal) 		No

Data Elements

DD Data Element ENROLLMENT-EFF-DATE • ELIGIBILITY-DETERMINANT-EFF-DATE • ELIGIBILITY-DETERMINANT-END-DATE • MSIS-IDENTIFICATION-NUM • ENROLLMENT-END-DATE • ELIGIBILITY-TERMINATION-REASON
DD Data Element Number ELG253 • ELG099 • ELG100 • ELG251 • ELG254 • ELG095

Annotation Calculate the percentage of beneficiaries who were enrolled in the previous month but who aren't enrolled in the current month that do not have an informative eligibility termination reason
Specification STEP 1: Enrolled any day of DQ report month

Define 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 >= first day of the DQ report month OR missing

3. MSIS-IDENTIFICATION-NUM is not missing



STEP 2: Enrolled any day of prior DQ report month

Define the prior 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 prior DQ report month

2. ENROLLMENT-END-DATE >= first day of the prior DQ report month OR missing

3. MSIS-IDENTIFICATION-NUM is not missing



STEP 3: Enrolled in prior month but not current month

Keep all MSIS IDs from STEP 2 that are NOT in STEP 1



STEP 4: Eligibility determinants any day of prior DQ report month

Using the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:

1. PRIMARY-ELIGIBILITY-GROUP-IND = 1

2. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the prior DQ report month

3. ELIGIBILITY-DETERMINANT-END-DATE >= first day of the prior DQ report month OR missing

*Note: If multiple segments meet the criteria for one MSIS ID, keep latest one (sort by max end date, max effective date, min record byte offset)



STEP 5: Valid, known eligibility termination reason

Of the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with:

1. ELIGIBILITY-TERMINATION-REASON = (“01”,“02”,“04”, “06”,”07”,“08”,“09”,“10”,“11”,“12”, “13”,“14”,“15”,“16”,“17”, “18”,“19”, “20”, “23”, “24”, “25”, “26”, “27”, “28”, “29”, “30”, or “31”)



STEP 6: Missing, invalid, unknown, or other eligibility termination reason

Keep all MSIS IDs from STEP 3 that are NOT in STEP 5



STEP 7: Calculate percentage

Divide the unique count of MSIS IDs from STEP 6 by the unique count of MSIS IDs from STEP 3