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Measure Name | # of managed care plan enrollees |
---|---|
File Type | ELG |
Measure ID | EL-10-003-2 |
Measure Type | Count |
Content area | ELG MCR MULTI |
Validation Type | Longitudinal |
---|
Measure Priority | Medium |
---|---|
Focus Area | Managed care |
Category | Program participation |
Claim Type | N/A |
---|---|
Adjustment Type | N/A |
Crossover Type | N/A |
Minimum | N/A |
---|---|
Maximum | N/A |
TA Minimun | |
TA Maximum | |
Longitudinal Threshold | 0.1 |
For TA
(for including in compliance training) |
TA- Longitudinal |
For TA
(Longitudinal) |
Yes |
DD Data Element | MSIS-IDENTIFICATION-NUM • MANAGED-CARE-PLAN-TYPE |
---|---|
DD Data Element Number | ELG191 • ELG193 |
Annotation | Count the total number of MSIS ID's that are enrolled in at least one managed care plan with a valid plan type |
---|---|
Specification |
STEP 1: Enrolled on the last day of DQ report month Define the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria: 1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing 3. MSIS-IDENTIFICATION-NUM is not missing STEP 2: Managed care enrollment on the last day of DQ report month Using the MSIS IDs that meet the criteria from STEP 1, join to segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria: 1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month 2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missing OR 1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing 2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missing STEP 3: Unique Valid Values Of the MSIS IDs which meet the criteria from STEP 2, restrict to those with a valid MANAGED-CARE-PLAN-TYPE: 1. MANAGED-CARE-PLAN-TYPE = "01", "02", "03", "04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14", "15", "16", "17", "18", "19", "20", "60", "70", "80" STEP 4: Count unique MSIS IDs Count the number of unique MSIS IDs from STEP 3 |