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Measure Name | % of MSIS IDs with any enrollment time span |
---|---|
File Type | Multiple Files |
Measure ID | EXP-45-004-4 |
Measure Type | Claims Percentage |
Content area | EXP |
Validation Type | Inferential |
---|
Measure Priority | Critical |
---|---|
Focus Area | N/A |
Category | File integrity |
Claim Type | Medicaid,Supp or CHIP,Supp |
---|---|
Adjustment Type | All Adjustment Types |
Crossover Type | All Indicators |
Minimum | 0.99 |
---|---|
Maximum | 1 |
TA Minimun | 0.99 |
TA Maximum | 1 |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | MSIS-IDENTIFICATION-NUM • MSIS-IDENTIFICATION-NUM • TRANSACTION-TYPE |
---|---|
DD Data Element Number | FTX383 • ELG251 • FTX388 |
Annotation | Calculate the percentage of PCCM capitation payment Financial Transaction records with a non-missing plan ID that do not have a corresponding managed care participation PCCM plan |
---|---|
Specification |
STEP 1: Active non-duplicate paid miscellaneous capitation payment financial transactions during report month Define the FTX universe for the FTX00095 table by keeping active records that satisfy the following criteria: 1. Reporting Period from the filename = DQ report month 2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND. STEP 2: Unique MSIS IDs From the records in STEP 1, create a list of unique MSIS-IDENTIFICATION-NUM values. STEP 3: Link FTX records to enrollment time span segment Of the unique MSIS-IDENTIFICATION-NUM values from STEP 2, restrict to those where: 1. MSIS-IDENTIFICATION-NUM is found on an ENROLLMENT-TIME-SPAN-ELG00021 segment STEP 4: Calculate percentage Divide the count of unique MSIS-IDENTIFICATION-NUM values from STEP 3 by the count from STEP 2 |