MCR-31-004-4

An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

Measure Name	% of MSIS IDs enrolled on Beginning Date of Service
File Type	Multiple Files
Measure ID	MCR-31-004-4
Measure Type	Claims percentage
Content area	MCR

Validation Type	Inferential

Measure Priority	N/A
Focus Area	N/A
Category	N/A

Claim Type	Medicaid,Enc
Adjustment Type	All Adjustment Types
Crossover Type	All Indicators

Minimum	0.95
Maximum	1
TA Minimun
TA Maximum
Longitudinal Threshold	N/A
For TA (for including in compliance training)	No
For TA (Longitudinal)	No

DD Data Element	ENROLLMENT-EFF-DATE • BEGINNING-DATE-OF-SERVICE • MSIS-IDENTIFICATION-NUM • ENROLLMENT-END-DATE • MSIS-IDENTIFICATION-NUM
DD Data Element Number	ELG253 • COT033 • ELG251 • ELG254 • COT022

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	MCR-31-004-4	UPDATE	Annotation	Calculate the percentage of MSIS IDs on Medicaid Encounter: original and adjustment, paid OT claims that can be found on an Eligible file enrollment time span segment that spans the date of service on the claims file	N/A
11/20/2025	4.0.22	MCR-31-004-4	UPDATE	Specification	STEP 1: Active non-duplicate OT records during DQ report monthDefine the OT records universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.STEP 2: Medicaid Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Non-missing beginning date of serviceOf the claims that meet the criteria from STEP 2, restrict to non-missing BEGINNING-DATE-OF-SERVICESTEP 4: Eligible any time and links to claimsDefine the ENROLLMENT-TIME-SPAN-ELG00021 file segment records that have an MSIS-ID that links to one of the claims identified in STEP 3STEP 5: Eligible during date of serviceFurther refine the eligible population by linking on MSIS-ID and keeping records that satisfy the following criteria:1. Claims BEGINNING-DATE-OF-SERVICE >= ENROLLMENT-EFF-DATE2. Claims BEGINNING-DATE-OF-SERVICE <= ENROLLMENT-END DATE OR ENROLLMENT-END DATE is missing STEP 6: Unique MSIS-IDs in eligibilityFrom the MSIS-IDs in STEP 5, limit to unique MSIS-IDs STEP 7: Unique MSIS-IDs in claimsOf the claims that meet the criteria from STEP 3, limit to unique MSIS-IDsSTEP 8: Calculate percentageDivide the count of MSIS-IDs from STEP 6 by the count of MSIS-IDs from STEP 7	N/A
04/24/2025	4.0.7	MCR-31-004-4	ADD	N/A		Created

MCR-31-004-4

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements