Official websites use .gov
A
.gov website belongs to an official government
organization in the United States.
Secure .gov websites use HTTPS
A
lock () or https:// means you've safely connected to
the .gov website. Share sensitive information only on official,
secure websites.
Measure Name | % MSIS IDs with a valid plan type that are missing plan ID |
---|---|
File Type | ELG |
Measure ID | EL-10-007-7 |
Measure Type | Non-Claims Percentage |
Content area | ELG |
Validation Type | Inferential |
---|
Measure Priority | N/A |
---|---|
Focus Area | N/A |
Category | N/A |
Claim Type | N/A |
---|---|
Adjustment Type | N/A |
Crossover Type | N/A |
Minimum | 0 |
---|---|
Maximum | 0.01 |
TA Minimun | |
TA Maximum | |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
No |
For TA
(Longitudinal) |
No |
DD Data Element | MSIS-IDENTIFICATION-NUM • MANAGED-CARE-PLAN-TYPE • MANAGED-CARE-PLAN-ID |
---|---|
DD Data Element Number | ELG191 • ELG193 • ELG192 |
Annotation | Calculate the percentage of unique MSIS ID's that have a valid managed care plan type and have a missing managed care plan ID |
---|---|
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: Valid managed care plan type 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” – “20” or “60” or “70” or “80” STEP 4: Missing Plan ID Of the MSIS IDs which meet the criteria from STEP 3, restrict to those with a missing plan ID 1. MANAGED-CARE-PLAN-ID is missing STEP 5: Percentage Divide the count of unique MSIS IDs from STEP 4 by the count in STEP 3 |