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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

MCR-54-005-5

Data Quality Measure
Last updated

Key Information

Measure Name # of plans with at least 100 capitations or 100 encounters, 0 enrollments
File Type ELG
Measure ID MCR-54-005-5
Measure Type Count
Content area MCR

Validation

Validation Type Inferential

Measure Priority

Measure Priority High
Focus Area Managed care
Category Program participation

Claim Information

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

Thresholds

Minimum 0
Maximum 0
TA Minimun 0
TA Maximum 0
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 • TYPE-OF-SERVICE • PLAN-ID-NUMBER • MANAGED-CARE-PLAN-TYPE • MANAGED-CARE-PLAN-ID • PLAN-ID-NUMBER • PLAN-ID-NUMBER • PLAN-ID-NUMBER • OFFSET-TRANS-TYPE • PAYEE-MCR-PLAN-TYPE • PAYMENT-OR-RECOUPMENT-AMOUNT • PAYMENT-AMOUNT • PAYEE-ID-TYPE • MBESCBES-FORM-GROUP • PAYMENT-OR-RECOUPMENT-AMOUNT
DD Data Element Number MCR019 • ELG193 • COT186 • CLT080 • MCR024 • ELG192 • CIP130 • CRX056 • COT066 • FTX184 • FTX036 • FTX157 • FTX072 • FTX034 • FTX048 • FTX025

Annotation Count plan ids in the EL-8-002-2 table with at least 100 capitations or 100 encounters that don't have enrollment
Specification STEP 1: Capitation or encounters without enrollment

Of the Plan_Ids identified in EL-8-002-2, count the non-missing Plan_Ids that satisfy the following criteria:

1a. Total_Capitation >= 100

OR

1b. Total_Encounters >= 100

AND

2. Enrollment = 0