MCR.002.019

STATE-PLAN-ID-NUM

Data Element

DE Number

MCR019

System DE Number

MCR.002.019

File Name

MCR - MANAGED CARE PLAN INFORMATION

File Segment Number

MCR00002

File Segment Name

MANAGED-CARE-MAIN

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The ID number a state issues to a managed care entity
Size	X(12)
FLF Start Position	22
FLF Stop Position	33
Segment Key Field Identifier	2
Coding Requirements	1. Value must be 12 characters or less 2. Value must not contain a pipe or asterisk symbols 3. 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-2558	If the plan ID number is populated on a managed care main segment from a MCR file, then the plan ID number must not contain any pipe or asterisk characters.
RULE-6174	If a segment is a managed care main segment from an MCR file, the state plan ID number value reported must be compatible with the specified T-MSIS picture format: X(12).

Measure ID	Measure Name
MCR-54-009-9	# of plans with at least 100 enrollments, capitations, or encounters, that do not have a managed care record
MCR-29-002-2	Operating Authority comparison with MMCDCS
MCR-29-001-1	Plan Type comparison with MMCDCS
EXP-26-002-2	% of total capitation amount paid on Plan IDs not found in Managed Care file
EL-8-001-1	Enrollment, capitation payments, and encounters by Plan Type
RULE-2382	% of record segments that do not have a managed care record
MCR-S-001-27	# of unique plan IDs
MCR-55-003-3	PACE capitation ratio
MCR-55-002-2	Enhanced PCCM capitation ratio
MCR-55-001-1	Traditional PCCM capitation ratio
MCR-54-010-10	# of plans where MC plan type does not match EL plan type
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
MCR-54-005-5	# of plans with at least 100 capitations or 100 encounters, 0 enrollments
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-54-003-3	# of plans with at least 100 enrollments or 100 encounters, 0 capitations
MCR-54-002-2	# of plans with at least 100 enrollments or 100 capitations, 0 encounters
MCR-54-001-1	# of plans with at least 100 enrollments, 0 capitations, 0 encounters
MCR-53-003-3	Total # of managed care encounters
MCR-53-002-2	Total # of managed care capitations
MCR-53-001-1	Total # of managed care enrollments
MCR-28-001-1	% of plan IDs with capitation payment ratios <0.9 or >1.1 (non-PCCM)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
MCR037	MCR.003.037	STATE-PLAN-ID-NUM	MCR00003	MANAGED-CARE-LOCATION-AND-CONTACT-INFO
MCR057	MCR.004.057	STATE-PLAN-ID-NUM	MCR00004	MANAGED-CARE-SERVICE-AREA
MCR066	MCR.005.066	STATE-PLAN-ID-NUM	MCR00005	MANAGED-CARE-OPERATING-AUTHORITY
MCR076	MCR.006.076	STATE-PLAN-ID-NUM	MCR00006	MANAGED-CARE-PLAN-POPULATION-ENROLLED
MCR085	MCR.007.085	STATE-PLAN-ID-NUM	MCR00007	MANAGED-CARE-ACCREDITATION-ORGANIZATION