Key Information

Measure Name	% of MSIS IDs with S-CHIP dental coverage (RESTRICTED-BENEFITS-CODE = C) that are not S-CHIP (CHIP-CODE not 3)
File Type	ELG
Measure ID	EL-6-030-30
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	0.01
TA Minimun	0
TA Maximum	0.01
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 • RESTRICTED-BENEFITS-CODE • CHIP-CODE
DD Data Element Number	ELG082 • ELG097 • ELG054

Annotation

Calculate the percentage of eligibles with restricted benefits through S-CHIP dental coverage, but are not identified as S-CHIP in CHIP-CODE

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: S-CHIP dental coverage Of the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping MSIS IDs where: 1. RESTRICTED-BENEFITS-CODE = "C" STEP 4: Variable demographics on the last day of DQ report month Using the MSIS IDs that meet the criteria from STEP 3, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria: 1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month 2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missing OR 1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing 2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missing STEP 5: Not S-CHIP O the MSIS IDs that meet the criteria from STEP 4, restrict to those where: 1. CHIP-CODE not equal to "3" or is missing STEP 6: Calculate percentage Divide the count of unique MSIS IDs from STEP 5 by the count of unique MSIS IDs from STEP 3