ELG.014.192

MANAGED-CARE-PLAN-ID

Data Element

DE Number

ELG192

System DE Number

ELG.014.192

File Name

ELG - ELIGIBLE

File Segment Number

ELG00014

File Segment Name

MANAGED-CARE-PARTICIPATION

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The managed care plan identification number under which the eligible individual is enrolled. See T-MSIS Guidance Document, "CMS Guidance: Best Practice for Reporting Managed-Care-Plan-ID in the Eligible File". https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47565 See T-MSIS Guidance Document, "CMS Guidance: Preliminary guidance for Primary Care Case Management Reporting". https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/52896
Size	X(12)
FLF Start Position	42
FLF Stop Position	53
Segment Key Field Identifier	3
Coding Requirements	1. Value must not contain a pipe or asterisk symbol 2. Value must be 12 characters or less 3. Value reported must match the value reported on State Plan Identification Number (MCR.002.019) 4. Mandatory

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-2379	If the plan ID is populated on a managed care participation segment from a MCR file, then the plan ID must not contain any pipe or asterisk characters.
RULE-2382	If the managed care plan ID is populated on a managed care participation ELG file segment and the managed care participation managed care plan enrollment end date is greater than the states tmsis cutover date then the effective and end dates on the managed care participation segment must fall within the effective and end dates of one or more continuous managed care main segments.
RULE-2384	If the managed care participation plan type is populated on a managed care participation segment and the managed care main plan type is populated on the managed care main file segment and the managed care participation managed care plan enrollment end date is greater than the states tmsis cutover date then managed care participation managed care plan type equals the managed care main managed care plan type and the effective and end dates on the managed care participation segment must fall within the effective and end dates of one or more continuous managed care main segments.
RULE-6564	If a segment is a managed care participation segment from an ELG file, the managed care plan ID value reported must be compatible with the specified T-MSIS picture format: X(12).
RULE-7407	If a segment is a managed care participation segment from an ELG file, and the MSIS ID is populated and the managed care plan type is equal to one of the following: '01', '02', '03','04','05','06', '07', '08', '09', '10', '11', '12', '13', '14', '15', '16', '17', '18', '19', '20', '60', '70', '80', and the managed care plan enrollment effective date is less than or equal to the enrollment end date and managed care plan enrollment end date is greater than or equal to the enrollment effective date, then the managed care plan ID must be populated.

Measure ID	Measure Name
MCR-65-011-11	% of Health/Medical Home (MANAGED-CARE-PLAN-TYPE = 70) enrollees with no capitation payments for Health/Medical Home
RULE-2382	% of record segments that do not have a managed care record
MCR-65-001-1	% of Comprehensive MCO (MANAGED-CARE-PLAN-TYPE = 01, 04) enrollees with no capitation payments for comprehensive MCO
MCR-65-002-2	% of PACE plan (MANAGED-CARE-PLAN-TYPE = 17) enrollees with no capitation payments for PACE
MCR-65-003-3	% of Transportation PAHP (MANAGED-CARE-PLAN-TYPE = 15) enrollees with no capitation payments for Transportation PAHPs
MCR-65-004-4	% of Dental PAHP (MANAGED-CARE-PLAN-TYPE = 14) enrollees with no capitation payments for Dental PAHPs
MCR-65-005-5	% of Pharmacy PAHP (MANAGED-CARE-PLAN-TYPE = 18) enrollees with no capitation payments for Pharmacy PAHPs
MCR-65-006-6	% of Mental Health PIHP (MANAGED-CARE-PLAN-TYPE = 08, 10, 12) enrollees with no capitation payments for Mental Health PIHPs
MCR-65-007-7	% of Mental Health PAHP (MANAGED-CARE-PLAN-TYPE = 09, 11, 13) enrollees with no capitation payments for Mental Health PAHPs
MCR-65-008-8	% 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
MIS-1-071-71	% distinct MSIS IDs with only missing values in any active segment: MANAGED-CARE-PLAN-ID (ELG00014)
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
EL-8-001-1	Enrollment, capitation payments, and encounters by Plan Type
EXP-26-001-1	Capitation payments by Plan ID (non-PCCM)
MCR-27-002-2	Encounters (by Claims file type) by Plan ID (non-PCCM)
MCR-13-018-20	% of PHP (TYPE-OF-SERVICE ) capitation payments with a non-missing plan ID that do not have a corresponding managed care participation PHP plan
MCR-9-018-20	% of PHP (TYPE-OF-SERVICE ) capitation payments with a non-missing plan ID that do not have a corresponding managed care participation PHP plan
MCR-13-019-21	% of Comprehensive MCO (TYPE-OF-SERVICE) capitation payments with a non-missing plan ID that do not have a corresponding managed care participation Comprehensive MCO plan
MCR-9-019-21	% of Comprehensive MCO (TYPE-OF-SERVICE) capitation payments with a non-missing plan ID that do not have a corresponding managed care participation Comprehensive MCO plan
RULE-7407	% of segments with a valid plan type that are missing plan ID
RULE-7408	% of segments with a non-missing plan ID that are missing plan type
MCR-54-001-1	# of plans with at least 100 enrollments, 0 capitations, 0 encounters
EL-10-007-7	% MSIS IDs with a valid plan type that are missing plan ID
EL-10-008-8	% of MSIS IDs with a non-missing plan ID that are missing plan type
EL-13-001-1	% of MC enrollments with a plan ID that does not link to a health plan affiliated with any provider in the provider file
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
EL-9-001-1	Enrollment by plan ID
MCR-13-006_1-18	% of PCCM (TYPE-OF-SERVICE) capitation payments with a non-missing plan ID that do not have a corresponding managed care participation PCCM plan
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
EL-10-002-4	Average # of managed care plans per enrollee
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
MCR-9-006_1-18	% of PCCM (TYPE-OF-SERVICE) capitation payments with a non-missing plan ID that do not have a corresponding managed care participation PCCM plan

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name