HHS-Official/devautomeasurecomparedownload

rowType stringclasses 2 values	tafVersionId int64 6 43	measureId float64 1 124 ⌀	stateId float64 1 78 ⌀	col0 stringclasses 57 values	col1 stringclasses 13 values	col2 stringclasses 121 values	col3 stringclasses 11 values	col4 stringclasses 7 values	col5 stringclasses 118 values	col6 stringlengths 1 26 ⌀	col7 stringclasses 2 values	col8 stringclasses 4 values
data	43	97	50	Vermont	Provider Information	Facilities - Classification Types	2023	Low concern	Percentage of facility providers with a valid, usable, and applicable value reported for at least one classification type in the T-MSIS Analytic Files (TAF)	100.0	TAF	Preliminary 1
data	43	96	50	Vermont	Provider Information	Facility Characteristics	2023	Unusable	Percentage of facility providers with a valid value reported for ownership code and profit status code in the T-MSIS Analytic Files (TAF)	0.0	TAF	Preliminary 1
data	43	102	50	Vermont	Provider Information	Provider Location	2023	Low concern	Percentage of participating providers without a usable service or practice location: ZIP code or county code	0.0	TAF	Preliminary 1
data	43	109	50	Vermont	Provider Information	National Provider Identifier	2023	Low concern	Percentage of TAF Annual Provider Files (APR) records with a valid NPI	98.8	TAF	Preliminary 1
data	43	98	50	Vermont	Managed Care Plans	Managed Care Plan Program and Population Characteristics	2023	Low concern	Percentage of records missing key managed care plan program and population characteristics in the T-MSIS Analytic Files (TAF)	0.0	TAF	Preliminary 1
data	43	99	50	Vermont	Managed Care Plans	Managed Care Plan Operational Characteristics	2023	Low concern	Percentage of records missing key managed care plan operational characteristics in the T-MSIS Analytic Files (TAF)	0.0	TAF	Preliminary 1
data	43	100	50	Vermont	Managed Care Plans	Plan Name and Type	2023	Low concern	Percentage of records missing managed care plan name or type in the T-MSIS Analytic Files (TAF)	0.0	TAF	Preliminary 1
data	43	108	78	Virgin Islands	Linking Across Files	Linking Claims to Beneficiaries	2023	Low concern	Percentage of service use records that do not link to an eligibility record in the same month of service in the T-MSIS Analytic Files (TAF)	0.3	TAF	Preliminary 1
data	43	110	78	Virgin Islands	Linking Across Files	Linking Expenditures to Beneficiaries	2023	Low concern	Percentage of absolute value of Medicaid and CHIP expenditures that do not link to an eligibility record in the month of service in the T-MSIS Analytic Files (TAF)	0.7	TAF	Preliminary 1
data	43	92	78	Virgin Islands	Linking Across Files	Linking Claims to Providers	2023	Low concern	Percentage of unique provider IDs on medical claims in the T-MSIS Analytic Files (TAF) that link to a provider ID on the TAF Annual Provider (APR) file	99.9	TAF	Preliminary 1
data	43	88	78	Virgin Islands	Linking Across Files	Linking Beneficiaries to Managed Care Plans	2023	Unclassified	Percentage of beneficiary-plan combinations in the T-MSIS Analytic Files (TAF) Demographic and Eligibility (DE) file that link to a plan ID in the TAF Annual Managed Care Plan (APL) file	Missing TAF data	TAF	Preliminary 1
data	43	7	78	Virgin Islands	Enrollment Benchmarking	Total Medicaid and CHIP Enrollment	2023	Unclassified	Average monthly percent difference in the count of Medicaid and CHIP beneficiaries with comprehensive benefits between the T-MSIS Analytic Files (TAF) and Performance Indicator (PI) data	Missing benchmark data	TAF	Preliminary 1
data	43	8	78	Virgin Islands	Enrollment Benchmarking	Medicaid-Only Enrollment	2023	Unclassified	Average monthly percent difference in the count of Medicaid beneficiaries with comprehensive benefits between the T-MSIS Analytic Files (TAF) and Performance Indicator (PI) data	Missing benchmark data	TAF	Preliminary 1
data	43	4	78	Virgin Islands	Enrollment Benchmarking	M-CHIP and S-CHIP Enrollment	2023	Unclassified	Average monthly percent difference in CHIP enrollment between the T-MSIS Analytic Files (TAF) and Performance Indicator (PI) data	Missing benchmark data	TAF	Preliminary 1
data	43	9	78	Virgin Islands	Enrollment Benchmarking	Dually Enrolled in Medicare	2023	Unclassified	Average percent difference in the count of dually eligible beneficiaries in March, June, September, and December between the T-MSIS Analytic Files (TAF) and Medicare Modernization Act (MMA) data	Missing benchmark data	TAF	Preliminary 1
data	43	1	78	Virgin Islands	Enrollment Benchmarking	Enrollment in CMC Plans	2023	Unclassified	Percent difference in comprehensive managed care (CMC) organization enrollment between the T-MSIS Analytic Files (TAF) and the Medicaid Managed Care Enrollment and Program Characteristics (MMCEPC) report	Not applicable	TAF	Preliminary 1
data	43	2	78	Virgin Islands	Enrollment Benchmarking	Enrollment in PCCM Programs	2023	Unclassified	Percent difference in primary care case management (PCCM) enrollment between the T-MSIS Analytic Files (TAF) and the Medicaid Managed Care Enrollment and Program Characteristics (MMCEPC) report	Not applicable	TAF	Preliminary 1
data	43	3	78	Virgin Islands	Enrollment Benchmarking	Enrollment in BHO Plans	2023	Unclassified	Percent difference in behavioral health organization (BHO) enrollment between the T-MSIS Analytic Files (TAF) and the Medicaid Managed Care Enrollment and Program Characteristics (MMCEPC) report	Not applicable	TAF	Preliminary 1
data	43	5	78	Virgin Islands	Enrollment Benchmarking	Adult Expansion Enrollment	2023	High concern	Average monthly percent difference in adult expansion group enrollment between the T-MSIS Analytic Files (TAF) and the Medicaid Budget and Expenditure System (MBES) data	-33.7	TAF	Preliminary 1
data	43	6	78	Virgin Islands	Enrollment Benchmarking	Newly Eligible Adult Enrollment	2023	Low concern	Average monthly percent difference in 'newly eligible' adult expansion group enrollment between the T-MSIS Analytic Files (TAF) and the Medicaid Budget and Expenditure System (MBES) data	0.0	TAF	Preliminary 1
data	43	82	78	Virgin Islands	Enrollment Benchmarking	1915(c) Participation	2023	Unclassified	Multiple criteria: (1) Percentage of total Medicaid beneficiaries in TAF particpating in 1915(c) waivers and (2) alignment of participant reporting in TAF with 1915(c) waiver status	See Background and Methods	TAF	Preliminary 1
data	43	122	78	Virgin Islands	Enrollment Benchmarking	SSI Participation	2023	Unclassified	Multiple criteria: Percent difference between TAF and SSI Annual Statistical Report using eligibility group codes, SSI indicator, and SSI status code	See Background and Methods	TAF	Preliminary 1
data	43	123	78	Virgin Islands	Enrollment Benchmarking	1115 Demonstration Identification	2023	Unusable	Multiple criteria: (1) Percentage of expected demonstration numbers present in the T-MSIS Analytic Files (TAF) and (2) the number of demonstration numbers unexpectedly present in TAF	See Background and Methods	TAF	Preliminary 1
data	43	10	78	Virgin Islands	Enrollment Patterns Over Time	Number of Enrollment Spans	2023	Medium concern	Multiple criteria: (1) Percentage of Medicaid and CHIP beneficiaries with only one enrollment span during the calendar year and (2) percentage of beneficiaries with three or more enrollment spans during the calendar year in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	11	78	Virgin Islands	Enrollment Patterns Over Time	Length of Enrollment Gaps	2023	Low concern	Multiple criteria: (1) Average length of enrollment gap (in days) for Medicaid and CHIP beneficiaries with an enrollment gap and (2) percentage of beneficiaries with an enrollment gap in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	12	78	Virgin Islands	Enrollment Patterns Over Time	Overlapping Enrollment Spans	2023	Low concern	Percentage of beneficiaries with overlapping Medicaid and S-CHIP enrollment spans in the T-MSIS Analytic Files (TAF)	0.0	TAF	Preliminary 1
data	43	13	78	Virgin Islands	Beneficiary Information	Age	2023	Low concern	Percentage of beneficiaries missing age values in the T-MSIS Analytic Files (TAF)	0.0	TAF	Preliminary 1
data	43	14	78	Virgin Islands	Beneficiary Information	Gender	2023	Low concern	Percentage of beneficiaries missing gender values in the T-MSIS Analytic Files (TAF)	0.0	TAF	Preliminary 1
data	43	16	78	Virgin Islands	Beneficiary Information	Race and Ethnicity	2023	Unclassified	Multiple criteria: (1) Percentage of beneficiaries missing race and/or ethnicity values in the T-MSIS Analytic Files (TAF) and (2) the number of race/ethnicity categories (out of 6) with a percentage point difference greater than 10 between the TAF and American Community Survey (ACS) data	See Background and Methods	TAF	Preliminary 1
data	43	17	78	Virgin Islands	Beneficiary Information	Income	2023	Medium concern	Percentage of beneficiaries missing family income values in the T-MSIS Analytic Files (TAF)	15.2	TAF	Preliminary 1
data	43	15	78	Virgin Islands	Beneficiary Information	ZIP Code	2023	Low concern	Percentage of beneficiaries missing ZIP code values in the T-MSIS Analytic Files (TAF)	0.0	TAF	Preliminary 1
data	43	20	78	Virgin Islands	Beneficiary Information	Eligibility Group Code	2023	Unclassified	Multiple criteria: (1) Percentage of beneficiaries missing an eligibility group code and (2) the number of large mandatory eligibility groups with no enrollment in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	18	78	Virgin Islands	Beneficiary Information	Dual Eligibility Code	2023	Unclassified	Multiple criteria: See Background and Methods	See Background and Methods	TAF	Preliminary 1
data	43	19	78	Virgin Islands	Beneficiary Information	CHIP Code	2023	Low concern	Multiple criteria: See Background and Methods	See Background and Methods	TAF	Preliminary 1
data	43	21	78	Virgin Islands	Beneficiary Information	Restricted Benefits Code	2023	Low concern	Percentage of Medicaid and CHIP beneficiaries with a known benefit type in the restricted benefits code field in the T-MSIS Analytic Files (TAF)	100.0	TAF	Preliminary 1
data	43	119	78	Virgin Islands	Beneficiary Information	Primary Language	2023	Unclassified	Multiple criteria: (1) Percentage of beneficiaries missing a primary language in the T-MSIS Analytic Files (TAF) and (2) the number of language categories (out of 3) in which TAF differs substantively from the American Community Survey (ACS)	See Background and Methods	TAF	Preliminary 1
data	43	120	78	Virgin Islands	Beneficiary Information	English Language Proficiency	2023	Unclassified	Multiple criteria: (1) Percentage of beneficiaries with a non-English primary language that are missing English proficiency in the T-MSIS Analytic Files (TAF) and (2) the percentage of beneficiaries with limited English proficiency in TAF that differs substantively from the American Community Survey (ACS)	See Background and Methods	TAF	Preliminary 1
data	43	124	78	Virgin Islands	Beneficiary Information	American Indian and Alaska Native Indicator	2023	Unusable	Percentage of beneficiaries with missing or invalid American Indian and Alaska Native Indicator values in the T-MSIS Analytic Files (TAF)	17.7	TAF	Preliminary 1
data	43	45	78	Virgin Islands	Claim Files Completeness	Claims Volume - IP	2023	High concern	Multiple criteria: (1) Total inpatient (IP) header volume as a percentage of the national median, (2) IP line volume as a percentage of the national median, and (3) average number of IP line records per header as a percentage of the national median in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	46	78	Virgin Islands	Claim Files Completeness	Claims Volume - LT	2023	Unclassified	Average number of long-term care (LT) line records per header as a percentage of the national median in the T-MSIS Analytic Files (TAF)	Missing TAF data	TAF	Preliminary 1
data	43	47	78	Virgin Islands	Claim Files Completeness	Claims Volume - OT	2023	High concern	Multiple criteria: (1) Total other service (OT) header volume as a percentage of the national median, (2) total OT line volume as a percentage of the national median, and (3) average number of OT line records per header as a percentage of the national median in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	48	78	Virgin Islands	Claim Files Completeness	Claims Volume - RX	2023	Medium concern	Multiple criteria: (1) Total pharmacy (RX) header volume as a percentage of the national median, (2) total RX line volume as a percentage of the national median, and (3) average number of RX line records per header as a percentage of the national median in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	27	78	Virgin Islands	Claim Files Completeness	Service Users - IP	2023	High concern	Percentage of non-dually eligible beneficiaries with at least one inpatient (IP) claim record in the T-MSIS Analytic Files (TAF), as a proportion of the national median	40.2	TAF	Preliminary 1
data	43	28	78	Virgin Islands	Claim Files Completeness	Service Users - OT	2023	Medium concern	Percentage of non-dually eligible beneficiaries with at least one other service (OT) claim record in the T-MSIS Analytic Files (TAF), as a proportion of the national median	72.2	TAF	Preliminary 1
data	43	29	78	Virgin Islands	Claim Files Completeness	Service Users - RX	2023	Medium concern	Percentage of non-dually eligible beneficiaries with at least one pharmacy (RX) claim record in the T-MSIS Analytic Files (TAF), as a proportion of the national median	50.3	TAF	Preliminary 1
data	43	121	78	Virgin Islands	Claim Files Completeness	Availability of CMC Plan Encounter Data	2023	Unclassified	Multiple criteria: Percentage of CMC plans with no IP or OT encounter header records in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	56	78	Virgin Islands	Claim Files Completeness	CMC Plan Encounters - IP	2023	Unclassified	Multiple criteria: (1) Inpatient (IP) comprehensive managed care (CMC) encounter header record volume as a percentage of the national median, (2) IP CMC encounter line record volume as a percentage of the national median, (3) the average number of IP CMC encounter line records per header as a percentage of the national median, and (4) the number of CMC plans with no IP encounter header records in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	57	78	Virgin Islands	Claim Files Completeness	CMC Plan Encounters - LT	2023	Unclassified	Multiple criteria: (1) The average number of long-term care (LT) comprehensive managed care (CMC) encounter line records per LT claim header as a percentage of the national median and (2) the number of CMC plans with no LT encounter header records in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	58	78	Virgin Islands	Claim Files Completeness	CMC Plan Encounters - OT	2023	Unclassified	Multiple criteria: (1) Other service (OT) comprehensive managed care (CMC) encounter header record volume as a percentage of the national median, (2) volume of OT CMC encounter line records as a percentage of the national median, (3) the average number of OT CMC line records per header as a percentage of the national median, and (4) the number of CMC plans with no OT encounter header records in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	59	78	Virgin Islands	Claim Files Completeness	CMC Plan Encounters - RX	2023	Unclassified	Multiple criteria: (1) The average number of pharmacy (RX) comprehensive managed care (CMC) encounter line records per RX claim header as a percentage of the national median and (2) the number of CMC plans with no RX encounter header records in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	22	78	Virgin Islands	Claim Files Completeness	Benchmarking Inpatient Stays - IP	2023	Unclassified	Percent difference in adult inpatient hospital stays between the T-MSIS Analytic Files (TAF) and the Healthcare Cost and Utilization Project (HCUP) data	Missing benchmark data	TAF	Preliminary 1
data	43	77	78	Virgin Islands	Expenditure Benchmarking	Total Medicaid Expenditures	2023	High concern	Percent difference in total Medicaid expenditures for medical assistance programs between the T-MSIS Analytic Files (TAF) and the CMS-64 data	-38.4	TAF	Preliminary 1
data	43	87	78	Virgin Islands	Expenditure Benchmarking	Medicaid Beneficiary Expenditures	2023	High concern	Percent difference in Medicaid beneficiary expenditures between the T-MSIS Analytic Files (TAF) and the CMS-64 data	-38.4	TAF	Preliminary 1
data	43	67	78	Virgin Islands	Expenditure Benchmarking	Total FFS Expenditures	2023	High concern	Percent difference in Medicaid fee-for-service (FFS) expenditures between the T-MSIS Analytic Files (TAF) and the CMS-64 data	-38.4	TAF	Preliminary 1
data	43	68	78	Virgin Islands	Expenditure Benchmarking	FFS Inpatient Expenditures	2023	Unusable	Percent difference in Medicaid fee-for-service (FFS) expenditures for inpatient hospital services between the T-MSIS Analytic Files (TAF) and the CMS-64 data	-73.5	TAF	Preliminary 1
data	43	69	78	Virgin Islands	Expenditure Benchmarking	FFS Long-Term Care Expenditures	2023	Unclassified	Percent difference in Medicaid fee-for-service (FFS) expenditures for institutional long-term care services between the T-MSIS Analytic Files (TAF) and the CMS-64 data	Missing TAF data	TAF	Preliminary 1
data	43	70	78	Virgin Islands	Expenditure Benchmarking	FFS Other Medical Expenditures	2023	Medium concern	Percent difference in Medicaid fee-for-service (FFS) expenditures for all other medical services between the T-MSIS Analytic Files (TAF) and the CMS-64 data	7.1	TAF	Preliminary 1
data	43	71	78	Virgin Islands	Expenditure Benchmarking	FFS Prescription Drug Expenditures	2023	Unusable	Percent difference in Medicaid fee-for-service (FFS) expenditures for prescription drugs between the T-MSIS Analytic Files (TAF) and the CMS-64 data	-62.1	TAF	Preliminary 1
data	43	72	78	Virgin Islands	Expenditure Benchmarking	Total Monthly Beneficiary Payments	2023	Unclassified	Percent difference in total monthly Medicaid beneficiary payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data	Not applicable	TAF	Preliminary 1
data	43	73	78	Virgin Islands	Expenditure Benchmarking	CMC Payments	2023	Unclassified	Percent difference in comprehensive managed care (CMC) capitation payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data	Not applicable	TAF	Preliminary 1
data	43	74	78	Virgin Islands	Expenditure Benchmarking	PHP Payments	2023	Unclassified	Percent difference in prepaid health plan (PHP) capitation payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data	Not applicable	TAF	Preliminary 1
data	43	75	78	Virgin Islands	Expenditure Benchmarking	PCCM Fees	2023	Unclassified	Percent difference in primary care case management plan (PCCM) fees between the T-MSIS Analytic Files (TAF) and the CMS-64 data	Not applicable	TAF	Preliminary 1
data	43	76	78	Virgin Islands	Expenditure Benchmarking	Premium Assistance Payments	2023	Unclassified	Percent difference in premium assistance payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data	Not applicable	TAF	Preliminary 1
data	43	66	78	Virgin Islands	Payments	Missing Payment Data - FFS Claims	2023	Low concern	Percentage of fee-for-service (FFS) claims with a zero, missing, or negative payment amount in the T-MSIS Analytic Files (TAF)	0.8	TAF	Preliminary 1
data	43	86	78	Virgin Islands	Payments	Missing Payment Data - Encounters	2023	Unclassified	Percentage of managed care (MC) encounters with a zero, missing, or negative payment amount in the T-MSIS Analytic Files (TAF)	Not applicable	TAF	Preliminary 1
data	43	101	78	Virgin Islands	Payments	Bundled Payments for Prenatal Care	2023	Medium concern	Percent of deliveries with bundled payment code including prenatal care in the T-MSIS Analytic Files (TAF)	17.1	TAF	Preliminary 1
data	43	81	78	Virgin Islands	Payments	Payment Data Consistency - IP	2023	Low concern	Multiple criteria: (1) Percentage of fee-for-service (FFS) inpatient (IP) claims with a header payment equal to the sum of its associated claim line payments and (2) percentage of IP claims with an unknown payment level in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	80	78	Virgin Islands	Payments	Payment Data Consistency - LT	2023	Unclassified	Multiple criteria: (1) Percentage of fee-for-service (FFS) long-term care (LT) claims with a header payment equal to the sum of its associated claim line payments and (2) percentage of LT claims with an unknown payment level in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	79	78	Virgin Islands	Payments	Payment Data Consistency - OT	2023	Low concern	Multiple criteria: (1) Percentage of fee-for-service (FFS) other service (OT) claims with a header payment equal to the sum of its associated claim line payments and (2) percentage of OT claims with an unknown payment level in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	78	78	Virgin Islands	Payments	Payment Data Consistency - RX	2023	Low concern	Multiple criteria: (1) Percentage of fee-for-service (FFS) pharmacy (RX) claims with a header payment equal to the sum of its associated claim line payments and (2) percentage of RX claims with an unknown payment level in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	111	78	Virgin Islands	Financial Reporting	Category of Service Code - IP	2023	Low concern	Percentage of IP lines that have a category of service code consistent with program enrollment	99.8	TAF	Preliminary 1
data	43	112	78	Virgin Islands	Financial Reporting	Category of Service Code - LT	2023	Unclassified	Percentage of LT lines that have a category of service code consistent with program enrollment	Missing TAF data	TAF	Preliminary 1
data	43	113	78	Virgin Islands	Financial Reporting	Category of Service Code - OT	2023	Low concern	Percentage of OT lines that have a category of service code consistent with program enrollment	95.0	TAF	Preliminary 1
data	43	114	78	Virgin Islands	Financial Reporting	Category of Service Code - RX	2023	Low concern	Percentage of RX lines that have a category of service code consistent with program enrollment	98.9	TAF	Preliminary 1
data	43	115	78	Virgin Islands	Financial Reporting	Federal Reimbursement Category Code - IP	2023	Low concern	Percentage of IP lines that have a federal reimbursement category consistent with program enrollment	99.8	TAF	Preliminary 1
data	43	116	78	Virgin Islands	Financial Reporting	Federal Reimbursement Category Code - LT	2023	Unclassified	Percentage of LT lines that have a federal reimbursement category consistent with program enrollment	Missing TAF data	TAF	Preliminary 1
data	43	117	78	Virgin Islands	Financial Reporting	Federal Reimbursement Category Code - OT	2023	Low concern	Percentage of OT lines that have a federal reimbursement category consistent with program enrollment	95.0	TAF	Preliminary 1
data	43	118	78	Virgin Islands	Financial Reporting	Federal Reimbursement Category Code - RX	2023	Low concern	Percentage of RX lines that have a federal reimbursement category consistent with program enrollment	98.9	TAF	Preliminary 1
data	43	49	78	Virgin Islands	Service Use Information	Diagnosis Code - IP	2023	Low concern	Percentage of inpatient (IP) header records with a valid ICD-10 primary diagnosis code in the T-MSIS Analytic Files (TAF)	92.7	TAF	Preliminary 1
data	43	50	78	Virgin Islands	Service Use Information	Diagnosis Code - LT	2023	Unclassified	Percentage of long-term care (LT) header records with a valid ICD-10 primary diagnosis code in the T-MSIS Analytic Files (TAF)	Missing TAF data	TAF	Preliminary 1
data	43	51	78	Virgin Islands	Service Use Information	Diagnosis Code - OT	2023	Low concern	Percentage of other service (OT) header records for outpatient hospital services, physician services, or clinic services with a valid ICD-10 primary diagnosis code in the T-MSIS Analytic Files (TAF)	93.6	TAF	Preliminary 1
data	43	65	78	Virgin Islands	Service Use Information	Procedure Codes - IP	2023	Low concern	Multiple criteria: (1) Percentage of inpatient (IP) header records with a missing primary procedure code, and (2) the percentage of IP header records with any invalid procedure codes in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	63	78	Virgin Islands	Service Use Information	Procedure Codes - OT Professional	2023	Low concern	Percentage of all other service (OT) professional claim line records with missing or invalid values in the procedure code field in the T-MSIS Analytic Files (TAF)	0.3	TAF	Preliminary 1
data	43	64	78	Virgin Islands	Service Use Information	Procedure Codes - OT Institutional	2023	Low concern	Percentage of all other service (OT) institutional claim line records with missing or invalid values in the procedure code field in the T-MSIS Analytic Files (TAF)	5.4	TAF	Preliminary 1
data	43	52	78	Virgin Islands	Service Use Information	Type of Service - IP	2023	Low concern	Percentage of inpatient (IP) claim line records with a missing or invalid type of service (TOS) code in the T-MSIS Analytic Files (TAF)	0.0	TAF	Preliminary 1
data	43	54	78	Virgin Islands	Service Use Information	Type of Service - LT	2023	Unclassified	Percentage of long-term care (LT) claim line records with a missing or invalid type of service (TOS) code in the T-MSIS Analytic Files (TAF)	Missing TAF data	TAF	Preliminary 1
data	43	53	78	Virgin Islands	Service Use Information	Type of Service - OT	2023	Low concern	Percentage of other service (OT) claim line records with a missing or invalid type of service (TOS) code in the T-MSIS Analytic Files (TAF)	0.0	TAF	Preliminary 1
data	43	55	78	Virgin Islands	Service Use Information	Type of Service - RX	2023	Low concern	Percentage of pharmacy (RX) claim line records with a missing or invalid type of service code (TOS) in the T-MSIS Analytic Files (TAF)	0.0	TAF	Preliminary 1
data	43	62	78	Virgin Islands	Service Use Information	Place of Service	2023	Low concern	Percentage of all other service (OT) header records with the expected combination of type of bill (TOB) code and place of service code (POS) in the T-MSIS Analytic Files (TAF)	100.0	TAF	Preliminary 1
data	43	41	78	Virgin Islands	Service Use Information	Admission Date - IP	2023	Low concern	Percentage of inpatient (IP) records with a missing or invalid admission date in the T-MSIS Analytic Files (TAF)	0.1	TAF	Preliminary 1
data	43	42	78	Virgin Islands	Service Use Information	Admission Date - LT	2023	Unclassified	Percentage of long-term care (LT) records with a missing or invalid admission date in the T-MSIS Analytic Files (TAF)	Missing TAF data	TAF	Preliminary 1
data	43	43	78	Virgin Islands	Service Use Information	Discharge Date - IP	2023	Low concern	Percentage of inpatient (IP) records with an unexpectedly missing or invalid discharge date in the T-MSIS Analytic Files (TAF)	0.1	TAF	Preliminary 1
data	43	44	78	Virgin Islands	Service Use Information	Discharge Date - LT	2023	Unclassified	Multiple criteria: Percentage of long-term care (LT) records with (1) a missing discharge date and (2) an unexpectedly missing or invalid discharge date in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	23	78	Virgin Islands	Service Use Information	Type of Bill - IP	2023	Low concern	Percentage of inpatient (IP) claim header records with an expected type of bill code in the T-MSIS Analytic Files (TAF)	100.0	TAF	Preliminary 1
data	43	24	78	Virgin Islands	Service Use Information	Type of Bill - LT	2023	Unclassified	Percentage of long-term care (LT) claim header records with an expected type of bill code in the T-MSIS Analytic Files (TAF)	Missing TAF data	TAF	Preliminary 1
data	43	25	78	Virgin Islands	Service Use Information	Type of Bill - OT	2023	Low concern	Multiple criteria: (1) Percentage of other service (OT) claim header records with an unexpected or invalid type of bill code and (2) percentage of OT claim header records with a missing type of bill code in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	40	78	Virgin Islands	Service Use Information	Generic Indicator - RX	2023	Low concern	Multiple criteria: See Background and Methods	See Background and Methods	TAF	Preliminary 1
data	43	89	78	Virgin Islands	Service Use Information	National Drug Code - RX	2023	Low concern	Percentage of pharmacy (RX) line records with a missing or invalid National Drug Code (NDC) code in the T-MSIS Analytic Files (TAF)	9.1	TAF	Preliminary 1
data	43	90	78	Virgin Islands	Service Use Information	Days' Supply, Quantity, and Units - RX	2023	Unusable	Percentage of pharmacy (RX) line records with either (1) a days' supply value that is missing, invalid, or greater than 180, or (2) a missing or unusable National Drug Code (NDC) quantity in the T-MSIS Analytic Files (TAF)	80.8	TAF	Preliminary 1
data	43	60	78	Virgin Islands	Non-Claim Records	Supplemental Payments	2023	Unclassified	Multiple criteria: See Background and Methods	See Background and Methods	TAF	Preliminary 1

data

43

97

50

Vermont

Provider Information

Facilities - Classification Types

2023

Low concern

Percentage of facility providers with a valid, usable, and applicable value reported for at least one classification type in the T-MSIS Analytic Files (TAF)

100.0

TAF

Preliminary 1

data

43

96

50

Vermont

Provider Information

Facility Characteristics

2023

Unusable

Percentage of facility providers with a valid value reported for ownership code and profit status code in the T-MSIS Analytic Files (TAF)

0.0

TAF

Preliminary 1

data

43

102

50

Vermont

Provider Information

Provider Location

2023

Low concern

Percentage of participating providers without a usable service or practice location: ZIP code or county code

0.0

TAF

Preliminary 1

data

43

109

50

Vermont

Provider Information

National Provider Identifier

2023

Low concern

Percentage of TAF Annual Provider Files (APR) records with a valid NPI

98.8

TAF

Preliminary 1

data

43

98

50

Vermont

Managed Care Plans

Managed Care Plan Program and Population Characteristics

2023

Low concern

Percentage of records missing key managed care plan program and population characteristics in the T-MSIS Analytic Files (TAF)

0.0

TAF

Preliminary 1

data

43

99

50

Vermont

Managed Care Plans

Managed Care Plan Operational Characteristics

2023

Low concern

Percentage of records missing key managed care plan operational characteristics in the T-MSIS Analytic Files (TAF)

0.0

TAF

Preliminary 1

data

43

100

50

Vermont

Managed Care Plans

Plan Name and Type

2023

Low concern

Percentage of records missing managed care plan name or type in the T-MSIS Analytic Files (TAF)

0.0

TAF

Preliminary 1

data

43

108

78

Virgin Islands

Linking Across Files

Linking Claims to Beneficiaries

2023

Low concern

Percentage of service use records that do not link to an eligibility record in the same month of service in the T-MSIS Analytic Files (TAF)

0.3

TAF

Preliminary 1

data

43

110

78

Virgin Islands

Linking Across Files

Linking Expenditures to Beneficiaries

2023

Low concern

Percentage of absolute value of Medicaid and CHIP expenditures that do not link to an eligibility record in the month of service in the T-MSIS Analytic Files (TAF)

0.7

TAF

Preliminary 1

data

43

92

78

Virgin Islands

Linking Across Files

Linking Claims to Providers

2023

Low concern

Percentage of unique provider IDs on medical claims in the T-MSIS Analytic Files (TAF) that link to a provider ID on the TAF Annual Provider (APR) file

99.9

TAF

Preliminary 1

data

43

88

78

Virgin Islands

Linking Across Files

Linking Beneficiaries to Managed Care Plans

2023

Unclassified

Percentage of beneficiary-plan combinations in the T-MSIS Analytic Files (TAF) Demographic and Eligibility (DE) file that link to a plan ID in the TAF Annual Managed Care Plan (APL) file

Missing TAF data

TAF

Preliminary 1

data

43

7

78

Virgin Islands

Enrollment Benchmarking

Total Medicaid and CHIP Enrollment

2023

Unclassified

Average monthly percent difference in the count of Medicaid and CHIP beneficiaries with comprehensive benefits between the T-MSIS Analytic Files (TAF) and Performance Indicator (PI) data

Missing benchmark data

TAF

Preliminary 1

data

43

8

78

Virgin Islands

Enrollment Benchmarking

Medicaid-Only Enrollment

2023

Unclassified

Average monthly percent difference in the count of Medicaid beneficiaries with comprehensive benefits between the T-MSIS Analytic Files (TAF) and Performance Indicator (PI) data

Missing benchmark data

TAF

Preliminary 1

data

43

4

78

Virgin Islands

Enrollment Benchmarking

M-CHIP and S-CHIP Enrollment

2023

Unclassified

Average monthly percent difference in CHIP enrollment between the T-MSIS Analytic Files (TAF) and Performance Indicator (PI) data

Missing benchmark data

TAF

Preliminary 1

data

43

9

78

Virgin Islands

Enrollment Benchmarking

Dually Enrolled in Medicare

2023

Unclassified

Average percent difference in the count of dually eligible beneficiaries in March, June, September, and December between the T-MSIS Analytic Files (TAF) and Medicare Modernization Act (MMA) data

Missing benchmark data

TAF

Preliminary 1

data

43

1

78

Virgin Islands

Enrollment Benchmarking

Enrollment in CMC Plans

2023

Unclassified

Percent difference in comprehensive managed care (CMC) organization enrollment between the T-MSIS Analytic Files (TAF) and the Medicaid Managed Care Enrollment and Program Characteristics (MMCEPC) report

Not applicable

TAF

Preliminary 1

data

43

2

78

Virgin Islands

Enrollment Benchmarking

Enrollment in PCCM Programs

2023

Unclassified

Percent difference in primary care case management (PCCM) enrollment between the T-MSIS Analytic Files (TAF) and the Medicaid Managed Care Enrollment and Program Characteristics (MMCEPC) report

Not applicable

TAF

Preliminary 1

data

43

3

78

Virgin Islands

Enrollment Benchmarking

Enrollment in BHO Plans

2023

Unclassified

Percent difference in behavioral health organization (BHO) enrollment between the T-MSIS Analytic Files (TAF) and the Medicaid Managed Care Enrollment and Program Characteristics (MMCEPC) report

Not applicable

TAF

Preliminary 1

data

43

5

78

Virgin Islands

Enrollment Benchmarking

Adult Expansion Enrollment

2023

High concern

Average monthly percent difference in adult expansion group enrollment between the T-MSIS Analytic Files (TAF) and the Medicaid Budget and Expenditure System (MBES) data

-33.7

TAF

Preliminary 1

data

43

6

78

Virgin Islands

Enrollment Benchmarking

Newly Eligible Adult Enrollment

2023

Low concern

Average monthly percent difference in 'newly eligible' adult expansion group enrollment between the T-MSIS Analytic Files (TAF) and the Medicaid Budget and Expenditure System (MBES) data

0.0

TAF

Preliminary 1

data

43

82

78

Virgin Islands

Enrollment Benchmarking

1915(c) Participation

2023

Unclassified

Multiple criteria: (1) Percentage of total Medicaid beneficiaries in TAF particpating in 1915(c) waivers and (2) alignment of participant reporting in TAF with 1915(c) waiver status

See Background and Methods

TAF

Preliminary 1

data

43

122

78

Virgin Islands

Enrollment Benchmarking

SSI Participation

2023

Unclassified

Multiple criteria: Percent difference between TAF and SSI Annual Statistical Report using eligibility group codes, SSI indicator, and SSI status code

See Background and Methods

TAF

Preliminary 1

data

43

123

78

Virgin Islands

Enrollment Benchmarking

1115 Demonstration Identification

2023

Unusable

Multiple criteria: (1) Percentage of expected demonstration numbers present in the T-MSIS Analytic Files (TAF) and (2) the number of demonstration numbers unexpectedly present in TAF

See Background and Methods

TAF

Preliminary 1

data

43

10

78

Virgin Islands

Enrollment Patterns Over Time

Number of Enrollment Spans

2023

Medium concern

Multiple criteria: (1) Percentage of Medicaid and CHIP beneficiaries with only one enrollment span during the calendar year and (2) percentage of beneficiaries with three or more enrollment spans during the calendar year in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

11

78

Virgin Islands

Enrollment Patterns Over Time

Length of Enrollment Gaps

2023

Low concern

Multiple criteria: (1) Average length of enrollment gap (in days) for Medicaid and CHIP beneficiaries with an enrollment gap and (2) percentage of beneficiaries with an enrollment gap in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

12

78

Virgin Islands

Enrollment Patterns Over Time

Overlapping Enrollment Spans

2023

Low concern

Percentage of beneficiaries with overlapping Medicaid and S-CHIP enrollment spans in the T-MSIS Analytic Files (TAF)

0.0

TAF

Preliminary 1

data

43

13

78

Virgin Islands

Beneficiary Information

Age

2023

Low concern

Percentage of beneficiaries missing age values in the T-MSIS Analytic Files (TAF)

0.0

TAF

Preliminary 1

data

43

14

78

Virgin Islands

Beneficiary Information

Gender

2023

Low concern

Percentage of beneficiaries missing gender values in the T-MSIS Analytic Files (TAF)

0.0

TAF

Preliminary 1

data

43

16

78

Virgin Islands

Beneficiary Information

Race and Ethnicity

2023

Unclassified

Multiple criteria: (1) Percentage of beneficiaries missing race and/or ethnicity values in the T-MSIS Analytic Files (TAF) and (2) the number of race/ethnicity categories (out of 6) with a percentage point difference greater than 10 between the TAF and American Community Survey (ACS) data

See Background and Methods

TAF

Preliminary 1

data

43

17

78

Virgin Islands

Beneficiary Information

Income

2023

Medium concern

Percentage of beneficiaries missing family income values in the T-MSIS Analytic Files (TAF)

15.2

TAF

Preliminary 1

data

43

15

78

Virgin Islands

Beneficiary Information

ZIP Code

2023

Low concern

Percentage of beneficiaries missing ZIP code values in the T-MSIS Analytic Files (TAF)

0.0

TAF

Preliminary 1

data

43

20

78

Virgin Islands

Beneficiary Information

Eligibility Group Code

2023

Unclassified

Multiple criteria: (1) Percentage of beneficiaries missing an eligibility group code and (2) the number of large mandatory eligibility groups with no enrollment in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

18

78

Virgin Islands

Beneficiary Information

Dual Eligibility Code

2023

Unclassified

Multiple criteria: See Background and Methods

See Background and Methods

TAF

Preliminary 1

data

43

19

78

Virgin Islands

Beneficiary Information

CHIP Code

2023

Low concern

Multiple criteria: See Background and Methods

See Background and Methods

TAF

Preliminary 1

data

43

21

78

Virgin Islands

Beneficiary Information

Restricted Benefits Code

2023

Low concern

Percentage of Medicaid and CHIP beneficiaries with a known benefit type in the restricted benefits code field in the T-MSIS Analytic Files (TAF)

100.0

TAF

Preliminary 1

data

43

119

78

Virgin Islands

Beneficiary Information

Primary Language

2023

Unclassified

Multiple criteria: (1) Percentage of beneficiaries missing a primary language in the T-MSIS Analytic Files (TAF) and (2) the number of language categories (out of 3) in which TAF differs substantively from the American Community Survey (ACS)

See Background and Methods

TAF

Preliminary 1

data

43

120

78

Virgin Islands

Beneficiary Information

English Language Proficiency

2023

Unclassified

Multiple criteria: (1) Percentage of beneficiaries with a non-English primary language that are missing English proficiency in the T-MSIS Analytic Files (TAF) and (2) the percentage of beneficiaries with limited English proficiency in TAF that differs substantively from the American Community Survey (ACS)

See Background and Methods

TAF

Preliminary 1

data

43

124

78

Virgin Islands

Beneficiary Information

American Indian and Alaska Native Indicator

2023

Unusable

Percentage of beneficiaries with missing or invalid American Indian and Alaska Native Indicator values in the T-MSIS Analytic Files (TAF)

17.7

TAF

Preliminary 1

data

43

45

78

Virgin Islands

Claim Files Completeness

Claims Volume - IP

2023

High concern

Multiple criteria: (1) Total inpatient (IP) header volume as a percentage of the national median, (2) IP line volume as a percentage of the national median, and (3) average number of IP line records per header as a percentage of the national median in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

46

78

Virgin Islands

Claim Files Completeness

Claims Volume - LT

2023

Unclassified

Average number of long-term care (LT) line records per header as a percentage of the national median in the T-MSIS Analytic Files (TAF)

Missing TAF data

TAF

Preliminary 1

data

43

47

78

Virgin Islands

Claim Files Completeness

Claims Volume - OT

2023

High concern

Multiple criteria: (1) Total other service (OT) header volume as a percentage of the national median, (2) total OT line volume as a percentage of the national median, and (3) average number of OT line records per header as a percentage of the national median in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

48

78

Virgin Islands

Claim Files Completeness

Claims Volume - RX

2023

Medium concern

Multiple criteria: (1) Total pharmacy (RX) header volume as a percentage of the national median, (2) total RX line volume as a percentage of the national median, and (3) average number of RX line records per header as a percentage of the national median in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

27

78

Virgin Islands

Claim Files Completeness

Service Users - IP

2023

High concern

Percentage of non-dually eligible beneficiaries with at least one inpatient (IP) claim record in the T-MSIS Analytic Files (TAF), as a proportion of the national median

40.2

TAF

Preliminary 1

data

43

28

78

Virgin Islands

Claim Files Completeness

Service Users - OT

2023

Medium concern

Percentage of non-dually eligible beneficiaries with at least one other service (OT) claim record in the T-MSIS Analytic Files (TAF), as a proportion of the national median

72.2

TAF

Preliminary 1

data

43

29

78

Virgin Islands

Claim Files Completeness

Service Users - RX

2023

Medium concern

Percentage of non-dually eligible beneficiaries with at least one pharmacy (RX) claim record in the T-MSIS Analytic Files (TAF), as a proportion of the national median

50.3

TAF

Preliminary 1

data

43

121

78

Virgin Islands

Claim Files Completeness

Availability of CMC Plan Encounter Data

2023

Unclassified

Multiple criteria: Percentage of CMC plans with no IP or OT encounter header records in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

56

78

Virgin Islands

Claim Files Completeness

CMC Plan Encounters - IP

2023

Unclassified

Multiple criteria: (1) Inpatient (IP) comprehensive managed care (CMC) encounter header record volume as a percentage of the national median, (2) IP CMC encounter line record volume as a percentage of the national median, (3) the average number of IP CMC encounter line records per header as a percentage of the national median, and (4) the number of CMC plans with no IP encounter header records in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

57

78

Virgin Islands

Claim Files Completeness

CMC Plan Encounters - LT

2023

Unclassified

Multiple criteria: (1) The average number of long-term care (LT) comprehensive managed care (CMC) encounter line records per LT claim header as a percentage of the national median and (2) the number of CMC plans with no LT encounter header records in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

58

78

Virgin Islands

Claim Files Completeness

CMC Plan Encounters - OT

2023

Unclassified

Multiple criteria: (1) Other service (OT) comprehensive managed care (CMC) encounter header record volume as a percentage of the national median, (2) volume of OT CMC encounter line records as a percentage of the national median, (3) the average number of OT CMC line records per header as a percentage of the national median, and (4) the number of CMC plans with no OT encounter header records in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

59

78

Virgin Islands

Claim Files Completeness

CMC Plan Encounters - RX

2023

Unclassified

Multiple criteria: (1) The average number of pharmacy (RX) comprehensive managed care (CMC) encounter line records per RX claim header as a percentage of the national median and (2) the number of CMC plans with no RX encounter header records in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

22

78

Virgin Islands

Claim Files Completeness

Benchmarking Inpatient Stays - IP

2023

Unclassified

Percent difference in adult inpatient hospital stays between the T-MSIS Analytic Files (TAF) and the Healthcare Cost and Utilization Project (HCUP) data

Missing benchmark data

TAF

Preliminary 1

data

43

77

78

Virgin Islands

Expenditure Benchmarking

Total Medicaid Expenditures

2023

High concern

Percent difference in total Medicaid expenditures for medical assistance programs between the T-MSIS Analytic Files (TAF) and the CMS-64 data

-38.4

TAF

Preliminary 1

data

43

87

78

Virgin Islands

Expenditure Benchmarking

Medicaid Beneficiary Expenditures

2023

High concern

Percent difference in Medicaid beneficiary expenditures between the T-MSIS Analytic Files (TAF) and the CMS-64 data

-38.4

TAF

Preliminary 1

data

43

67

78

Virgin Islands

Expenditure Benchmarking

Total FFS Expenditures

2023

High concern

Percent difference in Medicaid fee-for-service (FFS) expenditures between the T-MSIS Analytic Files (TAF) and the CMS-64 data

-38.4

TAF

Preliminary 1

data

43

68

78

Virgin Islands

Expenditure Benchmarking

FFS Inpatient Expenditures

2023

Unusable

Percent difference in Medicaid fee-for-service (FFS) expenditures for inpatient hospital services between the T-MSIS Analytic Files (TAF) and the CMS-64 data

-73.5

TAF

Preliminary 1

data

43

69

78

Virgin Islands

Expenditure Benchmarking

FFS Long-Term Care Expenditures

2023

Unclassified

Percent difference in Medicaid fee-for-service (FFS) expenditures for institutional long-term care services between the T-MSIS Analytic Files (TAF) and the CMS-64 data

Missing TAF data

TAF

Preliminary 1

data

43

70

78

Virgin Islands

Expenditure Benchmarking

FFS Other Medical Expenditures

2023

Medium concern

Percent difference in Medicaid fee-for-service (FFS) expenditures for all other medical services between the T-MSIS Analytic Files (TAF) and the CMS-64 data

7.1

TAF

Preliminary 1

data

43

71

78

Virgin Islands

Expenditure Benchmarking

FFS Prescription Drug Expenditures

2023

Unusable

Percent difference in Medicaid fee-for-service (FFS) expenditures for prescription drugs between the T-MSIS Analytic Files (TAF) and the CMS-64 data

-62.1

TAF

Preliminary 1

data

43

72

78

Virgin Islands

Expenditure Benchmarking

Total Monthly Beneficiary Payments

2023

Unclassified

Percent difference in total monthly Medicaid beneficiary payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data

Not applicable

TAF

Preliminary 1

data

43

73

78

Virgin Islands

Expenditure Benchmarking

CMC Payments

2023

Unclassified

Percent difference in comprehensive managed care (CMC) capitation payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data

Not applicable

TAF

Preliminary 1

data

43

74

78

Virgin Islands

Expenditure Benchmarking

PHP Payments

2023

Unclassified

Percent difference in prepaid health plan (PHP) capitation payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data

Not applicable

TAF

Preliminary 1

data

43

75

78

Virgin Islands

Expenditure Benchmarking

PCCM Fees

2023

Unclassified

Percent difference in primary care case management plan (PCCM) fees between the T-MSIS Analytic Files (TAF) and the CMS-64 data

Not applicable

TAF

Preliminary 1

data

43

76

78

Virgin Islands

Expenditure Benchmarking

Premium Assistance Payments

2023

Unclassified

Percent difference in premium assistance payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data

Not applicable

TAF

Preliminary 1

data

43

66

78

Virgin Islands

Payments

Missing Payment Data - FFS Claims

2023

Low concern

Percentage of fee-for-service (FFS) claims with a zero, missing, or negative payment amount in the T-MSIS Analytic Files (TAF)

0.8

TAF

Preliminary 1

data

43

86

78

Virgin Islands

Payments

Missing Payment Data - Encounters

2023

Unclassified

Percentage of managed care (MC) encounters with a zero, missing, or negative payment amount in the T-MSIS Analytic Files (TAF)

Not applicable

TAF

Preliminary 1

data

43

101

78

Virgin Islands

Payments

Bundled Payments for Prenatal Care

2023

Medium concern

Percent of deliveries with bundled payment code including prenatal care in the T-MSIS Analytic Files (TAF)

17.1

TAF

Preliminary 1

data

43

81

78

Virgin Islands

Payments

Payment Data Consistency - IP

2023

Low concern

Multiple criteria: (1) Percentage of fee-for-service (FFS) inpatient (IP) claims with a header payment equal to the sum of its associated claim line payments and (2) percentage of IP claims with an unknown payment level in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

80

78

Virgin Islands

Payments

Payment Data Consistency - LT

2023

Unclassified

Multiple criteria: (1) Percentage of fee-for-service (FFS) long-term care (LT) claims with a header payment equal to the sum of its associated claim line payments and (2) percentage of LT claims with an unknown payment level in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

79

78

Virgin Islands

Payments

Payment Data Consistency - OT

2023

Low concern

Multiple criteria: (1) Percentage of fee-for-service (FFS) other service (OT) claims with a header payment equal to the sum of its associated claim line payments and (2) percentage of OT claims with an unknown payment level in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

78

Virgin Islands

Payments

Payment Data Consistency - RX

2023

Low concern

Multiple criteria: (1) Percentage of fee-for-service (FFS) pharmacy (RX) claims with a header payment equal to the sum of its associated claim line payments and (2) percentage of RX claims with an unknown payment level in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

111

78

Virgin Islands

Financial Reporting

Category of Service Code - IP

2023

Low concern

Percentage of IP lines that have a category of service code consistent with program enrollment

99.8

TAF

Preliminary 1

data

43

112

78

Virgin Islands

Financial Reporting

Category of Service Code - LT

2023

Unclassified

Percentage of LT lines that have a category of service code consistent with program enrollment

Missing TAF data

TAF

Preliminary 1

data

43

113

78

Virgin Islands

Financial Reporting

Category of Service Code - OT

2023

Low concern

Percentage of OT lines that have a category of service code consistent with program enrollment

95.0

TAF

Preliminary 1

data

43

114

78

Virgin Islands

Financial Reporting

Category of Service Code - RX

2023

Low concern

Percentage of RX lines that have a category of service code consistent with program enrollment

98.9

TAF

Preliminary 1

data

43

115

78

Virgin Islands

Financial Reporting

Federal Reimbursement Category Code - IP

2023

Low concern

Percentage of IP lines that have a federal reimbursement category consistent with program enrollment

99.8

TAF

Preliminary 1

data

43

116

78

Virgin Islands

Financial Reporting

Federal Reimbursement Category Code - LT

2023

Unclassified

Percentage of LT lines that have a federal reimbursement category consistent with program enrollment

Missing TAF data

TAF

Preliminary 1

data

43

117

78

Virgin Islands

Financial Reporting

Federal Reimbursement Category Code - OT

2023

Low concern

Percentage of OT lines that have a federal reimbursement category consistent with program enrollment

95.0

TAF

Preliminary 1

data

43

118

78

Virgin Islands

Financial Reporting

Federal Reimbursement Category Code - RX

2023

Low concern

Percentage of RX lines that have a federal reimbursement category consistent with program enrollment

98.9

TAF

Preliminary 1

data

43

49

78

Virgin Islands

Service Use Information

Diagnosis Code - IP

2023

Low concern

Percentage of inpatient (IP) header records with a valid ICD-10 primary diagnosis code in the T-MSIS Analytic Files (TAF)

92.7

TAF

Preliminary 1

data

43

50

78

Virgin Islands

Service Use Information

Diagnosis Code - LT

2023

Unclassified

Percentage of long-term care (LT) header records with a valid ICD-10 primary diagnosis code in the T-MSIS Analytic Files (TAF)

Missing TAF data

TAF

Preliminary 1

data

43

51

78

Virgin Islands

Service Use Information

Diagnosis Code - OT

2023

Low concern

Percentage of other service (OT) header records for outpatient hospital services, physician services, or clinic services with a valid ICD-10 primary diagnosis code in the T-MSIS Analytic Files (TAF)

93.6

TAF

Preliminary 1

data

43

65

78

Virgin Islands

Service Use Information

Procedure Codes - IP

2023

Low concern

Multiple criteria: (1) Percentage of inpatient (IP) header records with a missing primary procedure code, and (2) the percentage of IP header records with any invalid procedure codes in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

63

78

Virgin Islands

Service Use Information

Procedure Codes - OT Professional

2023

Low concern

Percentage of all other service (OT) professional claim line records with missing or invalid values in the procedure code field in the T-MSIS Analytic Files (TAF)

0.3

TAF

Preliminary 1

data

43

64

78

Virgin Islands

Service Use Information

Procedure Codes - OT Institutional

2023

Low concern

Percentage of all other service (OT) institutional claim line records with missing or invalid values in the procedure code field in the T-MSIS Analytic Files (TAF)

5.4

TAF

Preliminary 1

data

43

52

78

Virgin Islands

Service Use Information

Type of Service - IP

2023

Low concern

Percentage of inpatient (IP) claim line records with a missing or invalid type of service (TOS) code in the T-MSIS Analytic Files (TAF)

0.0

TAF

Preliminary 1

data

43

54

78

Virgin Islands

Service Use Information

Type of Service - LT

2023

Unclassified

Percentage of long-term care (LT) claim line records with a missing or invalid type of service (TOS) code in the T-MSIS Analytic Files (TAF)

Missing TAF data

TAF

Preliminary 1

data

43

53

78

Virgin Islands

Service Use Information

Type of Service - OT

2023

Low concern

Percentage of other service (OT) claim line records with a missing or invalid type of service (TOS) code in the T-MSIS Analytic Files (TAF)

0.0

TAF

Preliminary 1

data

43

55

78

Virgin Islands

Service Use Information

Type of Service - RX

2023

Low concern

Percentage of pharmacy (RX) claim line records with a missing or invalid type of service code (TOS) in the T-MSIS Analytic Files (TAF)

0.0

TAF

Preliminary 1

data

43

62

78

Virgin Islands

Service Use Information

Place of Service

2023

Low concern

Percentage of all other service (OT) header records with the expected combination of type of bill (TOB) code and place of service code (POS) in the T-MSIS Analytic Files (TAF)

100.0

TAF

Preliminary 1

data

43

41

78

Virgin Islands

Service Use Information

Admission Date - IP

2023

Low concern

Percentage of inpatient (IP) records with a missing or invalid admission date in the T-MSIS Analytic Files (TAF)

0.1

TAF

Preliminary 1

data

43

42

78

Virgin Islands

Service Use Information

Admission Date - LT

2023

Unclassified

Percentage of long-term care (LT) records with a missing or invalid admission date in the T-MSIS Analytic Files (TAF)

Missing TAF data

TAF

Preliminary 1

data

43

78

Virgin Islands

Service Use Information

Discharge Date - IP

2023

Low concern

Percentage of inpatient (IP) records with an unexpectedly missing or invalid discharge date in the T-MSIS Analytic Files (TAF)

0.1

TAF

Preliminary 1

data

43

44

78

Virgin Islands

Service Use Information

Discharge Date - LT

2023

Unclassified

Multiple criteria: Percentage of long-term care (LT) records with (1) a missing discharge date and (2) an unexpectedly missing or invalid discharge date in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

23

78

Virgin Islands

Service Use Information

Type of Bill - IP

2023

Low concern

Percentage of inpatient (IP) claim header records with an expected type of bill code in the T-MSIS Analytic Files (TAF)

100.0

TAF

Preliminary 1

data

43

24

78

Virgin Islands

Service Use Information

Type of Bill - LT

2023

Unclassified

Percentage of long-term care (LT) claim header records with an expected type of bill code in the T-MSIS Analytic Files (TAF)

Missing TAF data

TAF

Preliminary 1

data

43

25

78

Virgin Islands

Service Use Information

Type of Bill - OT

2023

Low concern

Multiple criteria: (1) Percentage of other service (OT) claim header records with an unexpected or invalid type of bill code and (2) percentage of OT claim header records with a missing type of bill code in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

40

78

Virgin Islands

Service Use Information

Generic Indicator - RX

2023

Low concern

Multiple criteria: See Background and Methods

See Background and Methods

TAF

Preliminary 1

data

43

89

78

Virgin Islands

Service Use Information

National Drug Code - RX

2023

Low concern

Percentage of pharmacy (RX) line records with a missing or invalid National Drug Code (NDC) code in the T-MSIS Analytic Files (TAF)

9.1

TAF

Preliminary 1

data

43

90

78

Virgin Islands

Service Use Information

Days' Supply, Quantity, and Units - RX

2023

Unusable

Percentage of pharmacy (RX) line records with either (1) a days' supply value that is missing, invalid, or greater than 180, or (2) a missing or unusable National Drug Code (NDC) quantity in the T-MSIS Analytic Files (TAF)

80.8

TAF

Preliminary 1

data

43

60

78

Virgin Islands

Non-Claim Records

Supplemental Payments

2023

Unclassified

Multiple criteria: See Background and Methods

See Background and Methods

TAF

Preliminary 1