EXP-45-004-4

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TMSIS Dataguide

Medicaid.gov

Version:

EXP-45-004-4

Data Quality Measure

Last updated

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
Grace Period Expiration	01/30/2026

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	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	EXP-45-004-4	UPDATE	Annotation	Calculate the percentage of unique MSIS IDs on Medicaid and S-CHIP Payment Financial Transaction Records found on any enrollment time span segment	N/A
11/20/2025	4.0.22	EXP-45-004-4	UPDATE	Specification	STEP 1: Active non-duplicate paid miscellaneous payment financial transactions during report monthDefine the FTX universe for the FTX00095 table by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. 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 IDsFrom the records in STEP 1, create a list of unique MSIS-IDENTIFICATION-NUM values.STEP 3: Link FTX records to enrollment time span segmentOf 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 segmentSTEP 4: Calculate percentage Divide the count of unique MSIS-IDENTIFICATION-NUM values from STEP 3 by the count from STEP 2	N/A
10/07/2025	4.0.19	EXP-45-004-4	UPDATE	Grace period expiration date	None	2026-01-30
08/13/2025	4.0.16	EXP-45-004-4	UPDATE	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	Calculate the percentage of unique MSIS IDs on Medicaid and S-CHIP Payment Financial Transaction Records found on any enrollment time span segment
08/13/2025	4.0.16	EXP-45-004-4	UPDATE	Specification	STEP 1: Active non-duplicate paid miscellaneous capitation payment financial transactions during report monthDefine the FTX universe for the FTX00095 table by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. 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 IDsFrom the records in STEP 1, create a list of unique MSIS-IDENTIFICATION-NUM values.STEP 3: Link FTX records to enrollment time span segmentOf 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 segmentSTEP 4: Calculate percentage Divide the count of unique MSIS-IDENTIFICATION-NUM values from STEP 3 by the count from STEP 2	STEP 1: Active non-duplicate paid miscellaneous payment financial transactions during report monthDefine the FTX universe for the FTX00095 table by keeping active records that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. 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 IDsFrom the records in STEP 1, create a list of unique MSIS-IDENTIFICATION-NUM values.STEP 3: Link FTX records to enrollment time span segmentOf 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 segmentSTEP 4: Calculate percentage Divide the count of unique MSIS-IDENTIFICATION-NUM values from STEP 3 by the count from STEP 2
04/24/2025	4.0.7	EXP-45-004-4	ADD	N/A		Created