EL-6-028-28

Data Quality Measure

Last updated

Key Information

Measure Name	% of record segments with an invalid waiver ID format for 1115 waivers (WAIVER-TYPE = 01 or 21 - 30)
File Type	ELG
Measure ID	EL-6-028-28
Measure Type	Non-Claims Percentage
Content area	ELG

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	N/A
Focus Area	N/A
Category	N/A

Claim Information

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

Thresholds

Minimum	0
Maximum	0.01
TA Minimun
TA Maximum
Longitudinal Threshold	N/A
For TA (for including in compliance training)	No
For TA (Longitudinal)	No

Data Elements

DD Data Element	WAIVER-ID • WAIVER-TYPE
DD Data Element Number	ELG172 • ELG173

Annotation	Calculate the percentage of rows in the ELG00012 segment with an 1115 waiver type that have a waiver ID in an invalid format
Specification	STEP 1: Enrolled on the last 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 >= last day of the DQ report month OR missing 3. MSIS-IDENTIFICATION-NUM is not missing STEP 2: Waiver participation on the last day of DQ report month Using the MSIS IDs that meet the criteria from STEP 1, join to segment WAIVER-PARTICIPATION-ELG00012 by keeping records that satisfy the following criteria: 1a. WAIVER-ENROLLMENT-EFF-DATE <= last day of the DQ report month 2a. WAIVER-ENROLLMENT-END-DATE >= last day of the DQ report month OR missing OR 1b. WAIVER-ENROLLMENT-EFF-DATE is missing 2b. WAIVER-ENROLLMENT-END-DATE is missing STEP 3: 1115 waiver type Of the record segments that meet the criteria from STEP 2, keep those that satisfy the following criteria: 1. WAIVER-TYPE = "01" or ("21" - "30") STEP 4: Invalid waiver ID values Of the record segments that meet the criteria from STEP 3, define invalid WAIVER-ID values by counting the number of segments that meet the following criteria: 1. WAIVER-ID does not begin with (“11-W-“ OR “21-W-“) OR 2. WAIVER-ID does not contain [0-9] in positions 6-10 and 12 to end OR 3. WAIVER-ID position 11 is not "/" OR 4. WAIVER-ID is missing STEP 5: Calculate percentage Divide the count of record segments from STEP 4 by the count of record segments from STEP 3

Annotation

Calculate the percentage of rows in the ELG00012 segment with an 1115 waiver type that have a waiver ID in an invalid format

Specification

STEP 1: Enrolled on the last 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 >= last day of the DQ report month OR missing

3. MSIS-IDENTIFICATION-NUM is not missing

STEP 2: Waiver participation on the last day of DQ report month

Using the MSIS IDs that meet the criteria from STEP 1, join to segment WAIVER-PARTICIPATION-ELG00012 by keeping records that satisfy the following criteria:

1a. WAIVER-ENROLLMENT-EFF-DATE <= last day of the DQ report month

2a. WAIVER-ENROLLMENT-END-DATE >= last day of the DQ report month OR missing

OR

1b. WAIVER-ENROLLMENT-EFF-DATE is missing

2b. WAIVER-ENROLLMENT-END-DATE is missing

STEP 3: 1115 waiver type

Of the record segments that meet the criteria from STEP 2, keep those that satisfy the following criteria:

1. WAIVER-TYPE = "01" or ("21" - "30")

STEP 4: Invalid waiver ID values

Of the record segments that meet the criteria from STEP 3, define invalid WAIVER-ID values by counting the number of segments that meet the following criteria:

1. WAIVER-ID does not begin with (“11-W-“ OR “21-W-“)

OR

2. WAIVER-ID does not contain [0-9] in positions 6-10 and 12 to end

OR

3. WAIVER-ID position 11 is not "/"

OR

4. WAIVER-ID is missing

STEP 5: Calculate percentage

Divide the count of record segments from STEP 4 by the count of record segments from STEP 3