MCR-65-012-12
|
% of Integrated Care for Dual Eligibles (MANAGED-CARE-PLAN-TYPE = 80) enrollees with no capitation payments for Integrated Care for Dual Eligibles
|
MCR-65-001-1
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% of Comprehensive MCO (MANAGED-CARE-PLAN-TYPE = 01, 04) enrollees with no capitation payments for comprehensive MCO
|
MCR-65-002-2
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% of PACE plan (MANAGED-CARE-PLAN-TYPE = 17) enrollees with no capitation payments for PACE
|
MCR-65-003-3
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% of Transportation PAHP (MANAGED-CARE-PLAN-TYPE = 15) enrollees with no capitation payments for Transportation PAHPs
|
MCR-65-004-4
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% of Dental PAHP (MANAGED-CARE-PLAN-TYPE = 14) enrollees with no capitation payments for Dental PAHPs
|
MCR-65-005-5
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% of Pharmacy PAHP (MANAGED-CARE-PLAN-TYPE = 18) enrollees with no capitation payments for Pharmacy PAHPs
|
MCR-65-006-6
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% of Mental Health PIHP (MANAGED-CARE-PLAN-TYPE = 08, 10, 12) enrollees with no capitation payments for Mental Health PIHPs
|
MCR-65-007-7
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% of Mental Health PAHP (MANAGED-CARE-PLAN-TYPE = 09, 11, 13) enrollees with no capitation payments for Mental Health PAHPs
|
MCR-65-008-8
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% of LTSS (MANAGED-CARE-PLAN-TYPE = 07, 19) enrollees with no capitation payments for LTSS
|
MCR-65-009-9
|
% of Disease Management (MANAGED-CARE-PLAN-TYPE = 02, 03, 16) enrollees with no capitation payments for Disease Management
|
MCR-65-010-10
|
% of ACO (MANAGED-CARE-PLAN-TYPE = 60) enrollees with no capitation payments for ACOs
|
MCR-65-011-11
|
% of Health/Medical Home (MANAGED-CARE-PLAN-TYPE = 70) enrollees with no capitation payments for Health/Medical Home
|
RULE-7564
|
% of claim headers with a Procedure Code indicating a dental claim and non-missing Diagnosis Code Flag 1 that have a missing Diagnosis Code 1
|
EL-8-001-1
|
Enrollment, capitation payments, and encounters by Plan Type
|
EXP-26-001-1
|
Capitation payments by Plan ID (non-PCCM)
|
EXP-26-002-2
|
% of total capitation amount paid on Plan IDs not found in Managed Care file
|
EXP-26-003-3
|
% of total capitation amount paid with unknown or non-specified Plan IDs
|
MCR-27-001-1
|
Encounters (by Claim File Type)
|
MCR-27-002-2
|
Encounters (by Claims file type) by Plan ID (non-PCCM)
|
MIS-6-034-34
|
% missing: TYPE-OF-CLAIM (COT00002)
|
MCR-12-156-156
|
# of claim headers where the claim type indicates a sub-capitation payment (TYPE-OF-CLAIM = 6)
|
MCR-12-157-157
|
# of claim headers where the claim type indicates a sub-capitation payment (TYPE-OF-CLAIM = F)
|
RULE-7256
|
% missing: TYPE-OF-CLAIM (COT00002)
|
MCR-54-001-1
|
# of plans with at least 100 enrollments, 0 capitations, 0 encounters
|
ALL-24-001-1
|
Type of Claim values
|
ALL-27-001-1
|
# of Medicaid service tracking claim headers (TYPE-OF-CLAIM = 4)
|
ALL-27-002-2
|
# of Medicaid supplemental claim headers (TYPE-OF-CLAIM = 5)
|
EL-8-002-2
|
Enrollment, capitation payments, capitation ratios, encounters (by claim file type) and encounter ratios (by claim file type) by plan ID with plan ID linking to MC file
|
EXP-43-003-3
|
# of non-service tracking claim headers with non-missing Service Tracking Type
|
EXP-43-007-7
|
# of non-service tracking claim headers with non-missing Service Tracking Payment Amount
|
MCR-28-001-1
|
% of plan IDs with capitation payment ratios <0.9 or >1.1 (non-PCCM)
|
MCR-53-001-1
|
Total # of managed care enrollments
|
MCR-53-002-2
|
Total # of managed care capitations
|
MCR-53-003-3
|
Total # of managed care encounters
|
ALL-18-003-3
|
# of claim headers with TYPE-OF-CLAIM = U, V, W, X or Y that aren’t MFP (PROGRAM-TYPE = 08)
|
MCR-54-002-2
|
# of plans with at least 100 enrollments or 100 capitations, 0 encounters
|
MCR-54-003-3
|
# of plans with at least 100 enrollments or 100 encounters, 0 capitations
|
MCR-54-004-4
|
# of plans with at least 100 enrollments and some capitations that have capitation ratios outside of the expected range (0.7 - 1.3)
|
MCR-54-005-5
|
# of plans with at least 100 capitations or 100 encounters, 0 enrollments
|
MCR-54-009-9
|
# of plans with at least 100 enrollments, capitations, or encounters, that do not have a managed care record
|
MCR-54-010-10
|
# of plans where MC plan type does not match EL plan type
|
MCR-55-001-1
|
Traditional PCCM capitation ratio
|
MCR-55-002-2
|
Enhanced PCCM capitation ratio
|
MCR-55-003-3
|
PACE capitation ratio
|
MIS-17-001-1
|
% missing: TYPE-OF-CLAIM (COT00002)
|