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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

MCR-53-003-3

Data Quality Measure
Last updated

Key Information

Measure Name Total # of managed care encounters
File Type COT
Measure ID MCR-53-003-3
Measure Type Count
Content area MCR

Validation

Validation Type Inferential

Measure Priority

Measure Priority High
Focus Area Managed care
Category Utilization

Claim Information

Claim Type N/A
Adjustment Type N/A
Crossover Type N/A

Thresholds

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

Data Elements

DD Data Element STATE-PLAN-ID-NUM • MANAGED-CARE-PLAN-TYPE • ADJUSTMENT-IND • TYPE-OF-CLAIM • TYPE-OF-SERVICE • ADJUSTMENT-IND • TYPE-OF-CLAIM • TYPE-OF-CLAIM • PLAN-ID-NUMBER • MANAGED-CARE-PLAN-TYPE • MANAGED-CARE-PLAN-ID • ADJUSTMENT-IND • PLAN-ID-NUMBER • PLAN-ID-NUMBER • ADJUSTMENT-IND • PLAN-ID-NUMBER
DD Data Element Number MCR019 • ELG193 • CRX025 • COT037 • COT186 • CIP026 • CIP100 • CLT052 • CLT080 • MCR024 • ELG192 • COT025 • CIP130 • CRX056 • CLT025 • COT066

Annotation Sum total encounters for all plan ids in the EL-8-002-2 table, excluding those with plan types: 02, 03, 17, and 70
Specification STEP 1: Exclude Traditional PCCM, Enhanced PCCM, PACE, Health Home Plan Types

Of the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:

1. Plan_Type_El is not equal to ("02","03", "17", or "70")



STEP 2: Total encounters

Of the non-missing Plan_Ids that meet the criteria in STEP 1, sum Encounters_Total