EL-3-003-11

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TMSIS Dataguide

Medicaid.gov

Version:

EL-3-003-11

Data Quality Measure

Last updated

Key Information

Measure Name	% of MSIS IDs with age 65+ that are duals
File Type	ELG
Measure ID	EL-3-003-11
Measure Type	Non-Claims Percentage
Content area	ELG

Validation

Validation Type	Longitudinal and 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	0.85
Maximum	1
TA Minimun	0.75
TA Maximum	1
Longitudinal Threshold	0.05
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	MSIS-IDENTIFICATION-NUM • DUAL-ELIGIBLE-CODE
DD Data Element Number	ELG019 • ELG085

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	EL-3-003-11	UPDATE	Annotation	Calculate the percentage of eligibles 65 and older who are dual eligibles	N/A
11/20/2025	4.0.22	EL-3-003-11	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: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment PRIMARY-DEMOGRAPHICS-ELG00002 by keeping records that satisfy the following criteria:1a. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Calculate AgeOf the MSIS IDs that meet the criteria from STEP 2, calculate age:1a. If DATE-OF-DEATH is non-missing and occurs before the last day of the DQ report month, Age is equal to the years between DATE-OF-DEATH and DATE-OF-BIRTH.1b. Otherwise, Age is equal to the years between the last day of the DQ report month and DATE-OF-BIRTH. Note: Perform calculations to count full years (e.g., 5/1/2015 – 8/1/1950 = 64)STEP 4: Age 65 and olderOf the MSIS IDs that meet the criteria from STEP 3, further refine the population by keeping records with age >=65STEP 5: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 4, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 6: Dual eligibleOf the MSIS IDs that meet the criteria from STEP 5, further refine the population using DUAL-ELIGIBLE-CODE=“01” or “02” or “03” or “04” or “05” or “06” or “08” or “09” or “10” STEP 7: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 6 by the count of MSIS IDs from STEP 4	N/A
04/24/2025	4.0.7	EL-3-003-11	ADD	N/A		Created