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Measure Name | # of PCCM plans with at least 100 enrollments, capitations, or encounters, that do not have a managed care record |
---|---|
File Type | Multiple Files |
Measure ID | MCR-54-012-12 |
Measure Type | Count |
Content area | MCR |
Validation Type | Inferential |
---|
Measure Priority | Medium |
---|---|
Focus Area | Managed care |
Category | Managed care file |
Claim Type | N/A |
---|---|
Adjustment Type | N/A |
Crossover Type | N/A |
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 |
DD Data Element | TYPE-OF-SERVICE |
---|---|
DD Data Element Number | COT186 |
Annotation | Count plan ids in the EL-8-002-2 table with plan type equal to 02 and with at least 100 enrollments, 100 capitations, or 100 encounters that do not link to a plan id on the managed care file |
---|---|
Specification |
STEP 1: Traditional PCCM Of the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where: 1. Plan_Type_El = "02" STEP 2: Enrollment, capitation, or encounters Of the Plan_Ids that meet the criteria in STEP 1, further refine them by keeping those that satisfy the following criteria: 1a. Enrollment >= 100 OR 1b. Total_Capitation > 100 OR 1c. Total_Encounters >= 100 STEP 3: Do not link to managed care file Of the Plan_Ids that meet the criteria in STEP 1, count the non-missing Plan_Ids where: 1. In_MCR_File = "No" |