MCR-54-002-2

Data Quality Measure

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Key Information

Measure Name	# of plans with at least 100 enrollments or 100 capitations, 0 encounters
File Type	COT
Measure ID	MCR-54-002-2
Measure Type	Count
Content area	MCR

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	High
Focus Area	Managed care
Category	Utilization

Claim Information

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

Thresholds

Minimum	0
Maximum	0
TA Minimun	0
TA Maximum	0
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	PLAN-ID-NUMBER • PLAN-ID-NUMBER • PLAN-ID-NUMBER • PLAN-ID-NUMBER • MANAGED-CARE-PLAN-TYPE • STATE-PLAN-ID-NUM • MANAGED-CARE-PLAN-TYPE • MANAGED-CARE-PLAN-ID • TYPE-OF-SERVICE • ADJUSTMENT-IND • ADJUSTMENT-IND • ADJUSTMENT-IND • ADJUSTMENT-IND • TYPE-OF-CLAIM • TYPE-OF-CLAIM • TYPE-OF-CLAIM
DD Data Element Number	CIP130 • CLT080 • COT066 • CRX056 • MCR024 • MCR019 • ELG193 • ELG192 • COT186 • CIP026 • CLT025 • COT025 • CRX025 • CIP100 • CLT052 • COT037

Annotation	Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some capitations or at least 100 capitations and some enrollment that don't have encounters, excluding those with plan types: 02, 03, 17, 60, 70, 99, or missing
Specification	STEP 1: Exclude PCCM, PACE, Health Home, ACO, Missing Plan Types Of the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where: 1. Plan_Type_El is not equal to ("02","03", "17", "60", "70", or "99") or is missing STEP 2: Enrollment or capitation without encounters Of the Plan_Ids that meet the criteria in STEP 1, count the non-missing Plan_Ids that also satisfy the following criteria: 1a. Enrollment >= 100 2a. Total_Capitation > 0 OR 1b. Enrollment > 0 2b. Total_Capitation >= 100 AND 3. Total_Encounters = 0

Annotation

Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some capitations or at least 100 capitations and some enrollment that don't have encounters, excluding those with plan types: 02, 03, 17, 60, 70, 99, or missing

Specification

STEP 1: Exclude PCCM, PACE, Health Home, ACO, Missing Plan Types

Of the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:

1. Plan_Type_El is not equal to ("02","03", "17", "60", "70", or "99") or is missing

STEP 2: Enrollment or capitation without encounters

Of the Plan_Ids that meet the criteria in STEP 1, count the non-missing Plan_Ids that also satisfy the following criteria:

1a. Enrollment >= 100

2a. Total_Capitation > 0

OR

1b. Enrollment > 0

2b. Total_Capitation >= 100

AND

3. Total_Encounters = 0