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Measure Name | % of MSIS IDs with any enrollment time span |
---|---|
File Type | Multiple Files |
Measure ID | EXP-45-005-5 |
Measure Type | Claims Percentage |
Content area | EXP |
Validation Type | Inferential |
---|
Measure Priority | Critical |
---|---|
Focus Area | N/A |
Category | File integrity |
Claim Type | Medicaid,Supp or CHIP,Supp |
---|---|
Adjustment Type | All Adjustment Types |
Crossover Type | All Indicators |
Minimum | 0.99 |
---|---|
Maximum | 1 |
TA Minimun | 0.99 |
TA Maximum | 1 |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | MSIS-IDENTIFICATION-NUM • MSIS-IDENTIFICATION-NUM |
---|---|
DD Data Element Number | CLT022 • ELG251 |
Annotation | Calculate the percentage of unique MSIS IDs on Medicaid and S-CHIP Supplemental: Original and Adjustment, Paid LT Claims found on any enrollment time span segment |
---|---|
Specification |
STEP 1: Active non-duplicate LT records during DQ report month Define the LT records universe at the header level that satisfy the following criteria: 1. Reporting Period for the filename = DQ report month 2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing 3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing 4. TYPE-OF-CLAIM is not equal to "Z" or is missing 5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing 6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND. STEP 2: Medicaid and S-CHIP Supplemental: Original and Adjustment, Paid Claims Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria: 1. TYPE-OF-CLAIM = "5" or "E" STEP 3: Unique MSIS IDs From the claims in STEP 3, create a list of unique MSIS-IDENTIFICATION-NUM values. STEP 4: Link claims to enrollment time span segment Of the unique MSIS-IDENTIFICATION-NUM values from STEP 3, restrict to those where: 1. MSIS-IDENTIFICATION-NUM is found on an ENROLLMENT-TIME-SPAN-ELG00021 segment STEP 5: Calculate percentage Divide the count of unique MSIS-IDENTIFICATION-NUM values from STEP 4 by the count from STEP 3 |