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Measure Name | % of record segments with an invalid waiver ID format for 1115 waivers (WAIVER-TYPE = 01 or 21 - 30) |
---|---|
File Type | ELG |
Measure ID | EL-6-028-28 |
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 | WAIVER-TYPE • WAIVER-ID |
---|---|
DD Data Element Number | ELG173 • ELG172 |
Annotation | Calculate the percentage of rows in the ELG00012 segment with an 1115 waiver type that have a waiver ID in an invalid format |
---|---|
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: Waiver participation on the last day of DQ report month Using the MSIS IDs that meet the criteria from STEP 1, join to segment WAIVER-PARTICIPATION-ELG00012 by keeping records that satisfy the following criteria: 1a. WAIVER-ENROLLMENT-EFF-DATE <= last day of the DQ report month 2a. WAIVER-ENROLLMENT-END-DATE >= last day of the DQ report month OR missing OR 1b. WAIVER-ENROLLMENT-EFF-DATE is missing 2b. WAIVER-ENROLLMENT-END-DATE is missing STEP 3: 1115 waiver type Of the record segments that meet the criteria from STEP 2, keep those that satisfy the following criteria: 1. WAIVER-TYPE = "01" or ("21" - "30") STEP 4: Invalid waiver ID values Of the record segments that meet the criteria from STEP 3, define invalid WAIVER-ID values by counting the number of segments that meet the following criteria: 1. WAIVER-ID does not begin with (“11-W-“ OR “21-W-“) OR 2. WAIVER-ID does not contain [0-9] in positions 6-10 and 12 to end OR 3. WAIVER-ID position 11 is not "/" OR 4. WAIVER-ID is missing STEP 5: Calculate percentage Divide the count of record segments from STEP 4 by the count of record segments from STEP 3 |