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TMSIS Dataguide Medicaid.gov
Version 3.27.0

EL-3-000-12

Data Quality Measure
Last updated

No Updates

Key Information

Measure Name % of MSIS IDs without a valid Eligibility Group
File Type ELG
Measure ID EL-3-000-12
Measure Type Non-claims percentage
Content area ELG

Validation

Validation Type Inferential

Measure Priority

Measure Priority N/A
Focus Area N/A
Category N/A

Claim Information

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

Thresholds

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

Data Elements

DD Data Element MSIS-IDENTIFICATION-NUM • ELIGIBILITY-GROUP
DD Data Element Number ELG082 • ELG087

Annotation Calculate the percentage of unique MSIS IDs with a primary eligibility group indicator and with an invalid or missing eligibility group code of all unique MSIS IDs with a primary eligibility group indicator
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: Eligibility determinants on the last day of DQ report month

Using the MSIS IDs that meet the criteria from STEP 1, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:

1. PRIMARY-ELIGIBILITY-GROUP-IND = 1

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

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

OR

2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing

3b. ELIGIBILITY-DETERMINANT-END-DATE is missing



STEP 3: Invalid eligibility group

Of the MSIS IDs that meet the criteria from STEP 2, count the number of unique MSIS IDs where ELIGIBILITY-GROUP is not equal to (01-09 or 11-56 or 59-76)*



STEP 4: Percentage

Divide the count of unique MSIS IDs from STEP 3 by the count in STEP 1





*Note: This can include MSIS IDs from STEP 1 that did not join to an eligibility determinants segment.