EL-6-036-36

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TMSIS Dataguide

Medicaid.gov

Version:

EL-6-036-36

Data Quality Measure

Last updated

Key Information

Measure Name	% of duals missing Medicare Beneficiary Identifier
File Type	ELG
Measure ID	EL-6-036-36
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	0.02
TA Minimun	0
TA Maximum	0.02
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	MSIS-IDENTIFICATION-NUM • DUAL-ELIGIBLE-CODE • MEDICARE-BENEFICIARY-IDENTIFIER
DD Data Element Number	ELG082 • ELG085 • ELG051

Annotation

Calculate the percentage of duals missing a Medicare Beneficiary Identifier

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: Eligibility determinants on the last day of DQ report month

Using 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 = 1

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

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

OR

2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing

3b. ELIGIBILITY-DETERMINANT-END-DATE is missing

STEP 3: Dual eligibles

Of the MSIS IDs which meet the criteria from STEP 2, restrict to dual eligibles:

1. DUAL-ELIGIBLE-CODE equals ("01" or "02" or "03" or "04" or "05" or "06" or "08" or "09" or "10")

STEP 4: Variable demographics on the last day of DQ report month

Using the MSIS IDs that meet the criteria from STEP 3, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:

1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month

2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missing

OR

1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing

2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missing

STEP 5: Medicare Beneficiary Identifier is missing

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

1. MEDICARE-BENEFICIARY-IDENTIFIER is missing

STEP 6: Calculate percentage

Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 4

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/21/2025	4.0.22	EL-6-036-36	UPDATE	Annotation	N/A	Calculate the percentage of duals missing a Medicare Beneficiary Identifier
11/21/2025	4.0.22	EL-6-036-36	UPDATE	Specification	N/A	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 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 3: Dual eligiblesOf the MSIS IDs which meet the criteria from STEP 2, restrict to dual eligibles:1. DUAL-ELIGIBLE-CODE equals ("01" or "02" or "03" or "04" or "05" or "06" or "08" or "09" or "10")STEP 4: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: Medicare Beneficiary Identifier is missingOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1. MEDICARE-BENEFICIARY-IDENTIFIER is missingSTEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 4
11/20/2025	4.0.22	EL-6-036-36	UPDATE	Annotation	Calculate the percentage of duals missing a Medicare Beneficiary Identifier	N/A
11/20/2025	4.0.22	EL-6-036-36	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 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 3: Dual eligiblesOf the MSIS IDs which meet the criteria from STEP 2, restrict to dual eligibles:1. DUAL-ELIGIBLE-CODE equals ("01" or "02" or "03" or "04" or "05" or "06" or "08" or "09" or "10")STEP 4: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 5: Medicare Beneficiary Identifier is missingOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping MSIS IDs where:1. MEDICARE-BENEFICIARY-IDENTIFIER is missingSTEP 6: Calculate percentageDivide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 4	N/A
10/07/2025	4.0.19	EL-6-036-36	UPDATE	Grace period expiration date	None	2023-09-30
04/24/2025	4.0.7	EL-6-036-36	ADD	N/A		Created