Key Information

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

Validation Type	Inferential

Measure Priority

Measure Priority	Critical
Focus Area	N/A
Category	File integrity

Claim Information

Claim Type	Medicaid,Supp or CHIP,Supp
Adjustment Type	All Adjustment Types
Crossover Type	All Indicators

Thresholds

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

Data Elements

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