FFS-24-008-8

Data Quality Measure

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Key Information

Measure Name	% of MSIS IDs with any enrollment time span
File Type	Multiple Files
Measure ID	FFS-24-008-8
Measure Type	Claims percentage
Content area	FFS

Validation

Validation Type	Inferential

Measure Priority

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

Claim Information

Claim Type	CHIP,FFS
Adjustment Type	All Adjustment Types
Crossover Type	All Indicators

Thresholds

Minimum	0.99
Maximum	1
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 • MSIS-IDENTIFICATION-NUM
DD Data Element Number	CRX022 • ELG251

Annotation	Calculate the percentage of MSIS IDs on S-CHIP FFS: original and adjustment, paid RX claims that can be found on any Eligible file enrollment time span segment
Specification	STEP 1: Active non-duplicate RX records during DQ report month Define the RX 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: S-CHIP FFS: 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 = "A" STEP 3: Unique MSIS-IDs in claims Of the claims that meet the criteria from STEP 2, limit to unique MSIS-IDs STEP 4: Unique MSIS-IDs from Eligible file Identify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segment STEP 5: Link MSIS-IDs across files Count the number of MSIS-IDs from STEP 3 that are also in STEP 4 STEP 6: Calculate percentage Divide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3

Annotation

Calculate the percentage of MSIS IDs on S-CHIP FFS: original and adjustment, paid RX claims that can be found on any Eligible file enrollment time span segment

Specification

STEP 1: Active non-duplicate RX records during DQ report month

Define the RX 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: S-CHIP FFS: 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 = "A"

STEP 3: Unique MSIS-IDs in claims

Of the claims that meet the criteria from STEP 2, limit to unique MSIS-IDs

STEP 4: Unique MSIS-IDs from Eligible file

Identify the unique MSIS-IDs reported on the ENROLLMENT-TIME-SPAN-ELG00021 file segment

STEP 5: Link MSIS-IDs across files

Count the number of MSIS-IDs from STEP 3 that are also in STEP 4

STEP 6: Calculate percentage

Divide the count of MSIS-IDs from STEP 5 by the count of MSIS-IDs from STEP 3