ELG.014.196

MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE

Data Element

DE Number

ELG196

System DE Number

ELG.014.196

File Name

ELG - ELIGIBLE

File Segment Number

ELG00014

File Segment Name

MANAGED-CARE-PARTICIPATION

Last updated

09/12/2024

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The first calendar day on which all of the other data elements in the same segment were effective.
Size	9(8)
FLF Start Position	56
FLF Stop Position	63
Segment Key Field Identifier	(a)
Coding Requirements	1. Value must be 8 characters in the form "CCYYMMDD" 2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st) 3. Value must be before or the same as the associated Segment End Date value 4. Mandatory 5. Value of the CC component must be in [18,19,20]

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date
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RULE ID	RULE Definition
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-2389	If a segment is a managed care participation segment from an ELG file, then the managed care plan enrollment effective date value reported must be a valid date of the form CCYYMMDD.
RULE-2391	If managed care plan enrollment effective date and managed care plan enrollment end date are populated on a managed care participation segment from an ELG file, then the managed care plan enrollment effective date value reported must be before or equal to the managed care plan enrollment end date value reported.
RULE-7194	If plan ID is populated on a non-denied, non-void Medicaid, S-CHIP, or Other encounter from an IP file, then the plan ID must be equal to the plan ID on a managed care participation segment from an ELG file with the same MSIS ID and where the admission date on the claim is within the effective and end dates of the managed care participation segment.
RULE-7195	If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other encounter from an LT file, then the plan ID must be equal to the plan ID on a managed care participation segment from an ELG file with the same MSIS ID and effective and end dates that overlap the beginning date of service.
RULE-7196	If plan ID is populated on a non-denied, non-void Medicaid, S-CHIP, or Other encounter from an OT file, then the plan ID must be equal to the plan ID on a managed care participation segment from an ELG file with the same MSIS ID and enrollment effective and end dates that overlap the beginning date of service.
RULE-7197	If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other encounter from an RX file, then the plan ID must be equal to the plan ID on a managed care participation segment from an ELG file with the same MSIS ID and where the prescription fill date on the claim is within the effective and end dates of the managed care participation segment.
RULE-7706	If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other capitation from an OT file, then the plan ID must be equal to the plan ID on a managed care participation segment from an ELG file with the same MSIS ID and effective and end dates that overlap the beginning date of service.
RULE-7709	If the MSIS 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 or equal to the states tmsis cutover date then the effective and end dates on the managed care participation segment must fall with the effective and end dates of one or more continuous enrollment time span segments.

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Measure ID	Measure Name
EL-14-013-13	Ratio of errors for overlapping segment eff/end dates [RULE-2392] to all active MANAGED-CARE-PARTICIPATION (ELG00014) segments across all reporting and coverage periods
MIS-1-070-70	% distinct MSIS IDs with only missing values in any active segment: MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE (ELG00014)
RULE-2392	Ratio of errors for overlapping segment eff/end dates [RULE-2392] to all active MANAGED-CARE-PARTICIPATION (ELG00014) segments
RULE-7194	% of claim headers with a valid value for Plan ID Number that do not have a corresponding ELG Managed Care Participation segment for the same time period
RULE-7195	% of claim headers with a valid value for Plan ID Number that do not have a corresponding ELG Managed Care Participation segment for the same time period
RULE-7196	% of claim headers with a valid value for Plan ID Number that do not have a corresponding ELG Managed Care Participation segment for the same time period
RULE-7197	% of claim headers with a valid value for Plan ID Number that do not have a corresponding ELG Managed Care Participation segment for the same time period
RULE-7706	% of claim headers with a valid value for Plan ID Number that do not have a corresponding ELG Managed Care Participation segment for the same time period

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DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
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Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	ELG.014.196	UPDATE	Coding requirement	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in ['18', '19', '20']	1. Value must be 8 characters in the form "CCYYMMDD"2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st)3. Value must be before or the same as the associated Segment End Date value4. Mandatory5. Value of the CC component must be in [18,19,20]
09/21/2023	3.13.0	ELG.014.196	UPDATE	Segment key field identifier	Not Applicable	(a)