EL-3-007-4

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TMSIS Dataguide

Medicaid.gov

Version:

EL-3-007-4

Data Quality Measure

Last updated

Key Information

Measure Name	Pregnant Women (PW): % of MSIS IDs in ELIGIBILITY-GROUP = 05, 53, 67 or 68 (PW groups) with Age 13-64
File Type	ELG
Measure ID	EL-3-007-4
Measure Type	Non-Claims Percentage
Content area	ELG

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	Medium
Focus Area	N/A
Category	Beneficiary eligibility

Claim Information

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

Thresholds

Minimum	0.95
Maximum	1
TA Minimun	0.85
TA Maximum	1
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	ELIGIBILITY-GROUP • MSIS-IDENTIFICATION-NUM
DD Data Element Number	ELG087 • ELG082

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	EL-3-007-4	UPDATE	Annotation	Calculate the percentage of pregnant women that are between the ages of 13 and 64	N/A
11/20/2025	4.0.22	EL-3-007-4	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: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, 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 month 3a. 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 3: Unique Pregnant WomenOf the MSIS IDs that meet the criteria from STEP 2, select pregnant women:1. ELIGIBILITY-GROUP = "05" or "53" or "67" or "68"2. Remove any duplicates, so each MSIS ID only appears once.STEP 4: Primary demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, 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 month 2a. 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 5: Calculate AgeOf the MSIS IDs that meet the criteria from STEP 4, 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. STEP 6: Pregnant Women Aged 13-64MERGE MSIS IDs from STEP 3 and 5 and only keep the matches and make sure there is still only one observation per MSIS ID. Then, select women with ages between 13 and 64: Age >= 13 and Age <=64.STEP 7: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 6 by the count of MSIS IDs from STEP 3	N/A
04/24/2025	4.0.7	EL-3-007-4	ADD	N/A		Created