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TMSIS Dataguide Medicaid.gov
Version 3.27.0

MCR-54-006-6

Data Quality Measure
Last updated

Key Information

Measure Name # of plans with at least 100 enrollments and some encounters that have IP ratios outside of the expected range (0.01 - 2)
File Type Multiple Files
Measure ID MCR-54-006-6
Measure Type Count
Content area MCR

Validation

Validation Type Inferential

Measure Priority

Measure Priority Medium
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 TYPE-OF-SERVICE
DD Data Element Number COT186

Annotation Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some encounters that have an encounter IP ratio outside of (0.012, 2), with plan types equal to 01, 04, or 80
Specification STEP 1: Include Comprehensive MCO, HIO, and Integrated Care for Duals Plan Types

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

1. Plan_Type_El is equal to ("01","04", or "80")



STEP 2: Enrollment and encounters

Of the Plan_Ids that meet the criteria in STEP 1, further refine them by keeping those that satisfy the following criteria:

1. Enrollment >= 100

2. Total_Encounters > 0



STEP 3: Encounters IP ratio out of expected range

Of the Plan_Ids that meet the criteria in STEP 2, count the non-missing Plan_Ids where:

1. Encounters_Ip_Ratio < 0.01 OR Encounters_Ip_Ratio > 2