EL-19-001-1

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

EL-19-001-1

Data Quality Measure

Last updated

Key Information

Measure Name	% of MSIS IDs enrolled any day in the previous month but not any day in the current month, with missing, invalid, unknown, or other ELIGIBILITY-CHANGE-REASON
File Type	ELG
Measure ID	EL-19-001-1
Measure Type	Non-claims percentage
Content area	ELG

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	High
Focus Area	N/A
Category	Beneficiary eligibility

Claim Information

Claim Type	N/A
Adjustment Type	N/A
Crossover Type	N/A

Thresholds

Minimum	0
Maximum	0.5
TA Minimun	0
TA Maximum	0.5
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	MSIS-IDENTIFICATION-NUM • ENROLLMENT-EFF-DATE • ENROLLMENT-END-DATE • ELIGIBILITY-CHANGE-REASON • ELIGIBILITY-DETERMINANT-EFF-DATE • ELIGIBILITY-DETERMINANT-END-DATE
DD Data Element Number	ELG251 • ELG253 • ELG254 • ELG095 • ELG099 • ELG100

Annotation

Calculate the percentage of beneficiaries who were enrolled in the previous month but who aren't enrolled in the current month that do not have an informative eligibility change reason

Specification

STEP 1: Enrolled any 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 >= first day of the DQ report month OR missing

3. MSIS-IDENTIFICATION-NUM is not missing

STEP 2: Enrolled any day of prior DQ report month

Define the prior 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 prior DQ report month

2. ENROLLMENT-END-DATE >= first day of the prior DQ report month OR missing

3. MSIS-IDENTIFICATION-NUM is not missing

STEP 3: Enrolled in prior month but not current month

Keep all MSIS IDs from STEP 2 that are NOT in STEP 1

STEP 4: Eligibility determinants any day of prior DQ report month

Using the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:

1. PRIMARY-ELIGIBILITY-GROUP-IND = 1

2. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the prior DQ report month

3. ELIGIBILITY-DETERMINANT-END-DATE >= first day of the prior DQ report month OR missing

*Note: If multiple segments meet the criteria for one MSIS ID, keep latest one (sort by max end date, max effective date, min record byte offset)

STEP 5: Valid, known eligibility change reason

Of the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with:

1. ELIGIBILITY-CHANGE-REASON = (“01”,“02”,“04”, “06”,”07”,“08”,“09”,“10”,“11”,“12”, “13”,“14”,“15”,“16”,“17”, “18”,“19”, “20”, “23”, “24”, “25”, “26”, “27”, “28”, “29”, “30”, or “31”)

STEP 6: Missing, invalid, unknown, or other eligibility change reason

Keep all MSIS IDs from STEP 3 that are NOT in STEP 5

STEP 7: Calculate percentage

Divide the unique count of MSIS IDs from STEP 6 by the unique count of MSIS IDs from STEP 3

Published Date	Data Guide Version	DQM	Action	Field	Before	After
04/21/2023	3.6.0	EL-19-001-1	UPDATE	Specification	STEP 1: Enrolled any day of DQ report monthDefine 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 >= first day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Enrolled any day of prior DQ report monthDefine the prior 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 prior DQ report month 2. ENROLLMENT-END-DATE >= first day of the prior DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Enrolled in prior month but not current monthKeep all MSIS IDs from STEP 2 that are NOT in STEP 1STEP 4: Eligibility determinants any day of prior DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the prior DQ report month3. ELIGIBILITY-DETERMINANT-END-DATE >= first day of the prior DQ report month OR missing*Note: If multiple segments meet the criteria for one MSIS ID, keep latest one (sort by max end date, max effective date, min record byte offset)STEP 5: Valid, known eligibility change reasonOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with: 1. ELIGIBILITY-CHANGE-REASON = (“01”,“02”,“03”,“04”,“05”, “06”,”07”,“08”,“09”,“10”,“11”,“12”, “13”,“14”,“15”,“16”,“17”, “18”,“19”, or “20”)STEP 6: Missing, invalid, unknown, or other eligibility change reasonKeep all MSIS IDs from STEP 3 that are NOT in STEP 5STEP 7: Calculate percentageDivide the unique count of MSIS IDs from STEP 6 by the unique count of MSIS IDs from STEP 3	STEP 1: Enrolled any day of DQ report monthDefine 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 >= first day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Enrolled any day of prior DQ report monthDefine the prior 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 prior DQ report month 2. ENROLLMENT-END-DATE >= first day of the prior DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Enrolled in prior month but not current monthKeep all MSIS IDs from STEP 2 that are NOT in STEP 1STEP 4: Eligibility determinants any day of prior DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the prior DQ report month3. ELIGIBILITY-DETERMINANT-END-DATE >= first day of the prior DQ report month OR missing*Note: If multiple segments meet the criteria for one MSIS ID, keep latest one (sort by max end date, max effective date, min record byte offset)STEP 5: Valid, known eligibility change reasonOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with: 1. ELIGIBILITY-CHANGE-REASON = (“01”,“02”,“04”, “06”,”07”,“08”,“09”,“10”,“11”,“12”, “13”,“14”,“15”,“16”,“17”, “18”,“19”, “20”, “23”, “24”, “25”, “26”, “27”, “28”, “29”, “30”, or “31”)STEP 6: Missing, invalid, unknown, or other eligibility change reasonKeep all MSIS IDs from STEP 3 that are NOT in STEP 5STEP 7: Calculate percentageDivide the unique count of MSIS IDs from STEP 6 by the unique count of MSIS IDs from STEP 3
12/09/2022	3.0.6	EL-19-001-1	UPDATE	Specification	STEP 1: Enrolled any day of DQ report monthDefine 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 >= first day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Enrolled any day of prior DQ report monthDefine the prior 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 prior DQ report month 2. ENROLLMENT-END-DATE >= first day of the prior DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Enrolled in prior month but not current monthKeep all MSIS IDs from STEP 2 that are NOT in STEP 1STEP 4: Eligibility determinants any day of prior DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the prior DQ report month3. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the prior DQ report month OR missing*Note: If multiple segments meet the criteria for one MSIS ID, keep latest one (sort by max end date, max effective date, min record byte offset)STEP 5: Valid, known eligibility change reasonOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with: 1. ELIGIBILITY-CHANGE-REASON = (“01”,“02”,“03”,“04”,“05”, “06”,”07”,“08”,“09”,“10”,“11”,“12”, “13”,“14”,“15”,“16”,“17”, “18”,“19”, or “20”)STEP 6: Missing, invalid, unknown, or other eligibility change reasonKeep all MSIS IDs from STEP 3 that are NOT in STEP 5STEP 7: Calculate percentageDivide the unique count of MSIS IDs from STEP 6 by the unique count of MSIS IDs from STEP 3	STEP 1: Enrolled any day of DQ report monthDefine 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 >= first day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Enrolled any day of prior DQ report monthDefine the prior 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 prior DQ report month 2. ENROLLMENT-END-DATE >= first day of the prior DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 3: Enrolled in prior month but not current monthKeep all MSIS IDs from STEP 2 that are NOT in STEP 1STEP 4: Eligibility determinants any day of prior DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the prior DQ report month3. ELIGIBILITY-DETERMINANT-END-DATE >= first day of the prior DQ report month OR missing*Note: If multiple segments meet the criteria for one MSIS ID, keep latest one (sort by max end date, max effective date, min record byte offset)STEP 5: Valid, known eligibility change reasonOf the MSIS IDs that meet the criteria from STEP 4, further refine the population by keeping records with: 1. ELIGIBILITY-CHANGE-REASON = (“01”,“02”,“03”,“04”,“05”, “06”,”07”,“08”,“09”,“10”,“11”,“12”, “13”,“14”,“15”,“16”,“17”, “18”,“19”, or “20”)STEP 6: Missing, invalid, unknown, or other eligibility change reasonKeep all MSIS IDs from STEP 3 that are NOT in STEP 5STEP 7: Calculate percentageDivide the unique count of MSIS IDs from STEP 6 by the unique count of MSIS IDs from STEP 3