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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-7196

Data Quality Measure
Last updated

Key Information

Measure Name % of claim headers with a valid value for Plan ID Number that do not have a corresponding ELG Managed Care Participation segment for the same time period
File Type Multiple Files
Measure ID RULE-7196
Measure Type Claims Percentage
Content area ELG ALL MULTI

Validation

Validation Type Inferential

Measure Priority

Measure Priority High
Focus Area Managed care
Category Program participation

Claim Information

Claim Type Medicaid,Enc or CHIP,Enc
Adjustment Type Non-void
Crossover Type All Indicators

Thresholds

Minimum 0
Maximum 0.02
TA Minimun 0
TA Maximum 0.02
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		TA- Inferential
For TA
(Longitudinal) 		No

Data Elements

DD Data Element MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE • PLAN-ID-NUMBER • MANAGED-CARE-PLAN-ENROLLMENT-END-DATE • BEGINNING-DATE-OF-SERVICE
DD Data Element Number ELG196 • COT066 • ELG197 • COT033

Annotation N/A
Specification RULE-7196