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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

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 FTX383ELG251FTX388

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