EL-3-001-1

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TMSIS Dataguide

Medicaid.gov

Version 3.29.0

EL-3-001-1

Data Quality Measure

Last updated

Key Information

Measure Name	# of MSIS IDs with a valid Eligibility Group
File Type	ELG
Measure ID	EL-3-001-1
Measure Type	Count
Content area	ELG

Validation

Validation Type	Longitudinal

Measure Priority

Measure Priority	Medium
Focus Area	N/A
Category	Beneficiary eligibility

Claim Information

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

Thresholds

Minimum	N/A
Maximum	N/A
TA Minimun
TA Maximum
Longitudinal Threshold	0.05
For TA (for including in compliance training)	TA- Longitudinal
For TA (Longitudinal)	Yes

Data Elements

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

Annotation

Count the total number of eligible MSIS IDs with a valid ELIGIBILITY-GROUP

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 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: Unique Valid Codes

Of the MSIS IDs that meet the criteria from STEP 2, select those with a valid value for ELIGIBILITY-GROUP:

1. ELIGIBILITY-GROUP = "01" or "02" or "03" or "04" or "05" or "06" or "07" or "08" or "09" or "72" or "73" or "74" or "75" or "11" or "12" or "13" or "14" or "15" or "16" or "17" or "18" or "19" or "20" or "21" or "22" or "23" or "24" or "25" or "26" or "27" or "28" or "29" or "30" or "31" or "32" or "33" or "34" or "35" or "36" or "37" or "38" or "39" or "40" or "41" or "42" or "43" or "44" or "45" or "46" or "47" or "48" or "49" or "50" or "51" or "52" or "53" or "54" or "55" or "56" or "59" or "60" or "61" or "62" or "63" or "64" or "65" or "66" or "67" or "68" or "69" or "70" or "71" or "76"

2. Remove any duplicates, so each MSIS ID only appears once.

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/15/2023	3.16.0	EL-3-001-1	UPDATE	Specification	STEP 1: Enrolled on the last 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 month2. ENROLLMENT-END-DATE >= last day of the DQ report OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing 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 = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Unique Valid CodesOf the MSIS IDs that meet the criteria from STEP 2, select those with a valid value for ELIGIBILITY-GROUP:1. ELIGIBILITY-GROUP = "1" or "2" or "3" or "4" or "5" or "6" or "7" or "8" or "9" or "72" or "73" or "74" or "75" or "11" or "12" or "13" or "14" or "15" or "16" or "17" or "18" or "19" or "20" or "21" or "22" or "23" or "24" or "25" or "26" or "27" or "28" or "29" or "30" or "31" or "32" or "33" or "34" or "35" or "36" or "37" or "38" or "39" or "40" or "41" or "42" or "43" or "44" or "45" or "46" or "47" or "48" or "49" or "50" or "51" or "52" or "53" or "54" or "55" or "56" or "59" or "60" or "61" or "62" or "63" or "64" or "65" or "66" or "67" or "68" or "69" or "70" or "71" or "76"2. Remove any duplicates, so each MSIS ID only appears once.	STEP 1: Enrolled on the last 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 month2. ENROLLMENT-END-DATE >= last day of the DQ report OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Eligibility determinants on the last day of DQ report monthUsing 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 = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 3: Unique Valid CodesOf the MSIS IDs that meet the criteria from STEP 2, select those with a valid value for ELIGIBILITY-GROUP:1. ELIGIBILITY-GROUP = "01" or "02" or "03" or "04" or "05" or "06" or "07" or "08" or "09" or "72" or "73" or "74" or "75" or "11" or "12" or "13" or "14" or "15" or "16" or "17" or "18" or "19" or "20" or "21" or "22" or "23" or "24" or "25" or "26" or "27" or "28" or "29" or "30" or "31" or "32" or "33" or "34" or "35" or "36" or "37" or "38" or "39" or "40" or "41" or "42" or "43" or "44" or "45" or "46" or "47" or "48" or "49" or "50" or "51" or "52" or "53" or "54" or "55" or "56" or "59" or "60" or "61" or "62" or "63" or "64" or "65" or "66" or "67" or "68" or "69" or "70" or "71" or "76"2. Remove any duplicates, so each MSIS ID only appears once.