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	51	51	Virginia	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)	96.3	TAF	Preliminary 1
data	43	65	51	Virginia	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	51	Virginia	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)	0.5	TAF	Preliminary 1
data	43	64	51	Virginia	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)	4.1	TAF	Preliminary 1
data	43	52	51	Virginia	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	51	Virginia	Service Use Information	Type of Service - LT	2023	Low concern	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)	0.0	TAF	Preliminary 1
data	43	53	51	Virginia	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	51	Virginia	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	51	Virginia	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)	99.9	TAF	Preliminary 1
data	43	41	51	Virginia	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)	0.0	TAF	Preliminary 1
data	43	42	51	Virginia	Service Use Information	Admission Date - LT	2023	Low concern	Percentage of long-term care (LT) records with a missing or invalid admission date in the T-MSIS Analytic Files (TAF)	3.3	TAF	Preliminary 1
data	43	43	51	Virginia	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)	0.0	TAF	Preliminary 1
data	43	44	51	Virginia	Service Use Information	Discharge Date - LT	2023	Low concern	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	51	Virginia	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)	99.7	TAF	Preliminary 1
data	43	24	51	Virginia	Service Use Information	Type of Bill - LT	2023	Low concern	Percentage of long-term care (LT) claim header records with an expected type of bill code in the T-MSIS Analytic Files (TAF)	99.9	TAF	Preliminary 1
data	43	25	51	Virginia	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	51	Virginia	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	51	Virginia	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)	7.3	TAF	Preliminary 1
data	43	90	51	Virginia	Service Use Information	Days' Supply, Quantity, and Units - RX	2023	Low concern	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)	0.0	TAF	Preliminary 1
data	43	60	51	Virginia	Non-Claim Records	Supplemental Payments	2023	Unclassified	Multiple criteria: See Background and Methods	See Background and Methods	TAF	Preliminary 1
data	43	61	51	Virginia	Non-Claim Records	Non-Program (Other) Claims	2023	Low concern	Percentage of claim records with other, non-program claim type code in the T-MSIS Analytic Files (TAF)	0.0	TAF	Preliminary 1
data	43	85	51	Virginia	Non-Claim Records	Service Tracking Claims	2023	Low concern	Multiple criteria: Percentage of service tracking claims that meet any of the following criteria: (1) problematic MSIS ID value, (2) missing service tracking type code, or (3) missing service tracking payment in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	33	51	Virginia	Provider Information	Billing Provider NPI - IP	2023	Low concern	Percentage of records in the IP file with a missing billing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF)	0.0	TAF	Preliminary 1
data	43	34	51	Virginia	Provider Information	Billing Provider NPI - LT	2023	Low concern	Percentage of records in the LT file with a missing billing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF)	0.0	TAF	Preliminary 1
data	43	35	51	Virginia	Provider Information	Billing Provider NPI - OT	2023	Low concern	Percentage of records in the OT file with a missing billing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF)	0.4	TAF	Preliminary 1
data	43	36	51	Virginia	Provider Information	Billing Provider NPI - RX	2023	Low concern	Percentage of records in the RX file with a missing billing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF)	0.0	TAF	Preliminary 1
data	43	30	51	Virginia	Provider Information	Servicing Provider NPI - OT	2023	Low concern	Percentage of other service (OT) line records with a missing servicing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF)	0.2	TAF	Preliminary 1
data	43	31	51	Virginia	Provider Information	Prescribing Provider NPI - RX	2023	Low concern	Percentage of pharmacy (RX) header records with a missing prescribing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF)	0.0	TAF	Preliminary 1
data	43	32	51	Virginia	Provider Information	Dispensing Provider NPI - RX	2023	Low concern	Percentage of pharmacy (RX) header records with a missing dispensing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF)	0.0	TAF	Preliminary 1
data	43	37	51	Virginia	Provider Information	Billing Provider Type, Specialty, and Taxonomy - IP	2023	Low concern	Percentage of inpatient (IP) header records with an expected billing provider type, specialty, state-reported taxonomy, or NPPES taxonomy code in the T-MSIS Analytic Files (TAF)	98.5	TAF	Preliminary 1
data	43	38	51	Virginia	Provider Information	Billing Provider Type, Specialty, and Taxonomy - LT	2023	Low concern	Percentage of long-term care (LT) header records with an expected billing provider type, specialty, state-reported taxonomy, or NPPES primary taxonomy code in the T-MSIS Analytic Files (TAF)	99.9	TAF	Preliminary 1
data	43	104	51	Virginia	Provider Information	Billing Provider Type, Specialty, and Taxonomy - OT Professional	2023	Low concern	Percentage of header records on other service (OT) professional claims with a valid billing provider type, specialty, state-reported taxonomy, or NPPES primary taxonomy code in the T-MSIS Analytic Files (TAF)	99.9	TAF	Preliminary 1
data	43	105	51	Virginia	Provider Information	Billing Provider Type, Specialty, and Taxonomy - OT Institutional	2023	Low concern	Percentage of header records on other service (OT) institutional claims with a valid billing provider type, specialty, state-reported taxonomy, or NPPES primary taxonomy code in the T-MSIS Analytic Files (TAF)	100.0	TAF	Preliminary 1
data	43	103	51	Virginia	Provider Information	Billing Provider Specialty and Taxonomy - RX	2023	Unusable	Percentage of RX header records with an expected billing provider specialty or taxonomy code	0.0	TAF	Preliminary 1
data	43	106	51	Virginia	Provider Information	Servicing Provider Type, Specialty, and Taxonomy - OT Professional	2023	Low concern	Percentage of line records on other service (OT) professional claims with a valid servicing provider type, specialty, state-reported taxonomy, or NPPES primary taxonomy code in the T-MSIS Analytic Files (TAF)	99.8	TAF	Preliminary 1
data	43	107	51	Virginia	Provider Information	Servicing Provider Type, Specialty, and Taxonomy - OT Institutional	2023	Low concern	Percentage of line records on other service (OT) institutional claims with a valid servicing provider type, specialty, state-reported taxonomy, or NPPES primary taxonomy code in the T-MSIS Analytic Files (TAF)	100.0	TAF	Preliminary 1
data	43	26	51	Virginia	Provider Information	Hospital Type - IP	2023	Unusable	Percentage of inpatient (IP) claim header records with an expected type of hospital code in the T-MSIS Analytic Files (TAF)	0.5	TAF	Preliminary 1
data	43	91	51	Virginia	Provider Information	Active Enrollment Status Indicator	2023	High concern	Percentage of unique Annual Provider (APR) file provider IDs where the active enrollment status indicator aligns with the claims in the T-MSIS Analytic Files (TAF)	74.4	TAF	Preliminary 1
data	43	94	51	Virginia	Provider Information	Facility/Group/Individual Code	2023	Low concern	Multiple criteria: (1) Percentage of providers that are facility providers, (2) percentage of providers that are group providers, (3) percentage of providers that are individual providers, and (4) percentage of providers with a valid facility/group/individual code in the T-MSIS Analytic Files (TAF)	See Background and Methods	TAF	Preliminary 1
data	43	95	51	Virginia	Provider Information	Group and Individual Providers - Classification Types	2023	Low concern	Percentage of individual and group providers with a valid, usable, and applicable value reported for at least one classification type in the T-MSIS Analytic Files (TAF)	98.2	TAF	Preliminary 1
data	43	97	51	Virginia	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)	91.0	TAF	Preliminary 1
data	43	96	51	Virginia	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	51	Virginia	Provider Information	Provider Location	2023	Low concern	Percentage of participating providers without a usable service or practice location: ZIP code or county code	1.6	TAF	Preliminary 1
data	43	109	51	Virginia	Provider Information	National Provider Identifier	2023	Low concern	Percentage of TAF Annual Provider Files (APR) records with a valid NPI	91.3	TAF	Preliminary 1
data	43	98	51	Virginia	Managed Care Plans	Managed Care Plan Program and Population Characteristics	2023	High concern	Percentage of records missing key managed care plan program and population characteristics in the T-MSIS Analytic Files (TAF)	26.5	TAF	Preliminary 1
data	43	99	51	Virginia	Managed Care Plans	Managed Care Plan Operational Characteristics	2023	High concern	Percentage of records missing key managed care plan operational characteristics in the T-MSIS Analytic Files (TAF)	35.3	TAF	Preliminary 1
data	43	100	51	Virginia	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	53	Washington	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)	0.0	TAF	Preliminary 1
data	43	110	53	Washington	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)	14.6	TAF	Preliminary 1
data	43	92	53	Washington	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	98.9	TAF	Preliminary 1
data	43	88	53	Washington	Linking Across Files	Linking Beneficiaries to Managed Care Plans	2023	Low concern	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	100.0	TAF	Preliminary 1
data	43	7	53	Washington	Enrollment Benchmarking	Total Medicaid and CHIP Enrollment	2023	Low concern	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	1.2	TAF	Preliminary 1
data	43	8	53	Washington	Enrollment Benchmarking	Medicaid-Only Enrollment	2023	Low concern	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	1.7	TAF	Preliminary 1
data	43	4	53	Washington	Enrollment Benchmarking	M-CHIP and S-CHIP Enrollment	2023	Low concern	Average monthly percent difference in CHIP enrollment between the T-MSIS Analytic Files (TAF) and Performance Indicator (PI) data	0.2	TAF	Preliminary 1
data	43	9	53	Washington	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	53	Washington	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	Missing benchmark data	TAF	Preliminary 1
data	43	2	53	Washington	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	53	Washington	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	Missing benchmark data	TAF	Preliminary 1
data	43	5	53	Washington	Enrollment Benchmarking	Adult Expansion Enrollment	2023	Low 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	1.0	TAF	Preliminary 1
data	43	6	53	Washington	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	1.3	TAF	Preliminary 1
data	43	82	53	Washington	Enrollment Benchmarking	1915(c) Participation	2023	Low concern	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	53	Washington	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	53	Washington	Enrollment Benchmarking	1115 Demonstration Identification	2023	High concern	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	53	Washington	Enrollment Patterns Over Time	Number of Enrollment Spans	2023	Low 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	53	Washington	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	53	Washington	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	53	Washington	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	53	Washington	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	53	Washington	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	53	Washington	Beneficiary Information	Income	2023	Low concern	Percentage of beneficiaries missing family income values in the T-MSIS Analytic Files (TAF)	0.5	TAF	Preliminary 1
data	43	15	53	Washington	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	53	Washington	Beneficiary Information	Eligibility Group Code	2023	Medium concern	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	53	Washington	Beneficiary Information	Dual Eligibility Code	2023	Low concern	Multiple criteria: See Background and Methods	See Background and Methods	TAF	Preliminary 1
data	43	19	53	Washington	Beneficiary Information	CHIP Code	2023	Low concern	Multiple criteria: See Background and Methods	See Background and Methods	TAF	Preliminary 1
data	43	21	53	Washington	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)	99.1	TAF	Preliminary 1
data	43	119	53	Washington	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	53	Washington	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	53	Washington	Beneficiary Information	American Indian and Alaska Native Indicator	2023	Low concern	Percentage of beneficiaries with missing or invalid American Indian and Alaska Native Indicator values in the T-MSIS Analytic Files (TAF)	4.9	TAF	Preliminary 1
data	43	45	53	Washington	Claim Files Completeness	Claims Volume - IP	2023	Low 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	53	Washington	Claim Files Completeness	Claims Volume - LT	2023	Low concern	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)	84.3	TAF	Preliminary 1
data	43	47	53	Washington	Claim Files Completeness	Claims Volume - OT	2023	Low 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	53	Washington	Claim Files Completeness	Claims Volume - RX	2023	Low 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	53	Washington	Claim Files Completeness	Service Users - IP	2023	Low 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	78.7	TAF	Preliminary 1
data	43	28	53	Washington	Claim Files Completeness	Service Users - OT	2023	Low 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	100.3	TAF	Preliminary 1
data	43	29	53	Washington	Claim Files Completeness	Service Users - RX	2023	Low 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	99.8	TAF	Preliminary 1
data	43	121	53	Washington	Claim Files Completeness	Availability of CMC Plan Encounter Data	2023	Low concern	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	53	Washington	Claim Files Completeness	CMC Plan Encounters - IP	2023	Medium concern	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	53	Washington	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	53	Washington	Claim Files Completeness	CMC Plan Encounters - OT	2023	Medium concern	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	53	Washington	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	53	Washington	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	53	Washington	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	-41.5	TAF	Preliminary 1
data	43	87	53	Washington	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	-41.7	TAF	Preliminary 1
data	43	67	53	Washington	Expenditure Benchmarking	Total FFS Expenditures	2023	Medium concern	Percent difference in Medicaid fee-for-service (FFS) expenditures between the T-MSIS Analytic Files (TAF) and the CMS-64 data	-11.0	TAF	Preliminary 1
data	43	68	53	Washington	Expenditure Benchmarking	FFS Inpatient Expenditures	2023	Medium concern	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	-7.5	TAF	Preliminary 1
data	43	69	53	Washington	Expenditure Benchmarking	FFS Long-Term Care Expenditures	2023	Medium concern	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	-17.6	TAF	Preliminary 1
data	43	70	53	Washington	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	-9.6	TAF	Preliminary 1
data	43	71	53	Washington	Expenditure Benchmarking	FFS Prescription Drug Expenditures	2023	High concern	Percent difference in Medicaid fee-for-service (FFS) expenditures for prescription drugs between the T-MSIS Analytic Files (TAF) and the CMS-64 data	-28.5	TAF	Preliminary 1
data	43	72	53	Washington	Expenditure Benchmarking	Total Monthly Beneficiary Payments	2023	Unusable	Percent difference in total monthly Medicaid beneficiary payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data	-56.0	TAF	Preliminary 1
data	43	73	53	Washington	Expenditure Benchmarking	CMC Payments	2023	Unusable	Percent difference in comprehensive managed care (CMC) capitation payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data	-53.4	TAF	Preliminary 1

data

43

51

Virginia

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)

96.3

TAF

Preliminary 1

data

43

65

51

Virginia

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

51

Virginia

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)

0.5

TAF

Preliminary 1

data

43

64

51

Virginia

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)

4.1

TAF

Preliminary 1

data

43

52

51

Virginia

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

51

Virginia

Service Use Information

Type of Service - LT

2023

Low concern

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)

0.0

TAF

Preliminary 1

data

43

53

51

Virginia

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

51

Virginia

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

51

Virginia

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)

99.9

TAF

Preliminary 1

data

43

41

51

Virginia

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)

0.0

TAF

Preliminary 1

data

43

42

51

Virginia

Service Use Information

Admission Date - LT

2023

Low concern

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

3.3

TAF

Preliminary 1

data

43

51

Virginia

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)

0.0

TAF

Preliminary 1

data

43

44

51

Virginia

Service Use Information

Discharge Date - LT

2023

Low concern

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

51

Virginia

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)

99.7

TAF

Preliminary 1

data

43

24

51

Virginia

Service Use Information

Type of Bill - LT

2023

Low concern

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

99.9

TAF

Preliminary 1

data

43

25

51

Virginia

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

51

Virginia

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

51

Virginia

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)

7.3

TAF

Preliminary 1

data

43

90

51

Virginia

Service Use Information

Days' Supply, Quantity, and Units - RX

2023

Low concern

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)

0.0

TAF

Preliminary 1

data

43

60

51

Virginia

Non-Claim Records

Supplemental Payments

2023

Unclassified

Multiple criteria: See Background and Methods

See Background and Methods

TAF

Preliminary 1

data

43

61

51

Virginia

Non-Claim Records

Non-Program (Other) Claims

2023

Low concern

Percentage of claim records with other, non-program claim type code in the T-MSIS Analytic Files (TAF)

0.0

TAF

Preliminary 1

data

43

85

51

Virginia

Non-Claim Records

Service Tracking Claims

2023

Low concern

Multiple criteria: Percentage of service tracking claims that meet any of the following criteria: (1) problematic MSIS ID value, (2) missing service tracking type code, or (3) missing service tracking payment in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

33

51

Virginia

Provider Information

Billing Provider NPI - IP

2023

Low concern

Percentage of records in the IP file with a missing billing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF)

0.0

TAF

Preliminary 1

data

43

34

51

Virginia

Provider Information

Billing Provider NPI - LT

2023

Low concern

Percentage of records in the LT file with a missing billing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF)

0.0

TAF

Preliminary 1

data

43

35

51

Virginia

Provider Information

Billing Provider NPI - OT

2023

Low concern

Percentage of records in the OT file with a missing billing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF)

0.4

TAF

Preliminary 1

data

43

36

51

Virginia

Provider Information

Billing Provider NPI - RX

2023

Low concern

Percentage of records in the RX file with a missing billing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF)

0.0

TAF

Preliminary 1

data

43

30

51

Virginia

Provider Information

Servicing Provider NPI - OT

2023

Low concern

Percentage of other service (OT) line records with a missing servicing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF)

0.2

TAF

Preliminary 1

data

43

31

51

Virginia

Provider Information

Prescribing Provider NPI - RX

2023

Low concern

Percentage of pharmacy (RX) header records with a missing prescribing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF)

0.0

TAF

Preliminary 1

data

43

32

51

Virginia

Provider Information

Dispensing Provider NPI - RX

2023

Low concern

Percentage of pharmacy (RX) header records with a missing dispensing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF)

0.0

TAF

Preliminary 1

data

43

37

51

Virginia

Provider Information

Billing Provider Type, Specialty, and Taxonomy - IP

2023

Low concern

Percentage of inpatient (IP) header records with an expected billing provider type, specialty, state-reported taxonomy, or NPPES taxonomy code in the T-MSIS Analytic Files (TAF)

98.5

TAF

Preliminary 1

data

43

38

51

Virginia

Provider Information

Billing Provider Type, Specialty, and Taxonomy - LT

2023

Low concern

Percentage of long-term care (LT) header records with an expected billing provider type, specialty, state-reported taxonomy, or NPPES primary taxonomy code in the T-MSIS Analytic Files (TAF)

99.9

TAF

Preliminary 1

data

43

104

51

Virginia

Provider Information

Billing Provider Type, Specialty, and Taxonomy - OT Professional

2023

Low concern

Percentage of header records on other service (OT) professional claims with a valid billing provider type, specialty, state-reported taxonomy, or NPPES primary taxonomy code in the T-MSIS Analytic Files (TAF)

99.9

TAF

Preliminary 1

data

43

105

51

Virginia

Provider Information

Billing Provider Type, Specialty, and Taxonomy - OT Institutional

2023

Low concern

Percentage of header records on other service (OT) institutional claims with a valid billing provider type, specialty, state-reported taxonomy, or NPPES primary taxonomy code in the T-MSIS Analytic Files (TAF)

100.0

TAF

Preliminary 1

data

43

103

51

Virginia

Provider Information

Billing Provider Specialty and Taxonomy - RX

2023

Unusable

Percentage of RX header records with an expected billing provider specialty or taxonomy code

0.0

TAF

Preliminary 1

data

43

106

51

Virginia

Provider Information

Servicing Provider Type, Specialty, and Taxonomy - OT Professional

2023

Low concern

Percentage of line records on other service (OT) professional claims with a valid servicing provider type, specialty, state-reported taxonomy, or NPPES primary taxonomy code in the T-MSIS Analytic Files (TAF)

99.8

TAF

Preliminary 1

data

43

107

51

Virginia

Provider Information

Servicing Provider Type, Specialty, and Taxonomy - OT Institutional

2023

Low concern

Percentage of line records on other service (OT) institutional claims with a valid servicing provider type, specialty, state-reported taxonomy, or NPPES primary taxonomy code in the T-MSIS Analytic Files (TAF)

100.0

TAF

Preliminary 1

data

43

26

51

Virginia

Provider Information

Hospital Type - IP

2023

Unusable

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

0.5

TAF

Preliminary 1

data

43

91

51

Virginia

Provider Information

Active Enrollment Status Indicator

2023

High concern

Percentage of unique Annual Provider (APR) file provider IDs where the active enrollment status indicator aligns with the claims in the T-MSIS Analytic Files (TAF)

74.4

TAF

Preliminary 1

data

43

94

51

Virginia

Provider Information

Facility/Group/Individual Code

2023

Low concern

Multiple criteria: (1) Percentage of providers that are facility providers, (2) percentage of providers that are group providers, (3) percentage of providers that are individual providers, and (4) percentage of providers with a valid facility/group/individual code in the T-MSIS Analytic Files (TAF)

See Background and Methods

TAF

Preliminary 1

data

43

95

51

Virginia

Provider Information

Group and Individual Providers - Classification Types

2023

Low concern

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

98.2

TAF

Preliminary 1

data

43

97

51

Virginia

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)

91.0

TAF

Preliminary 1

data

43

96

51

Virginia

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

51

Virginia

Provider Information

Provider Location

2023

Low concern

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

1.6

TAF

Preliminary 1

data

43

109

51

Virginia

Provider Information

National Provider Identifier

2023

Low concern

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

91.3

TAF

Preliminary 1

data

43

98

51

Virginia

Managed Care Plans

Managed Care Plan Program and Population Characteristics

2023

High concern

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

26.5

TAF

Preliminary 1

data

43

99

51

Virginia

Managed Care Plans

Managed Care Plan Operational Characteristics

2023

High concern

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

35.3

TAF

Preliminary 1

data

43

100

51

Virginia

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

53

Washington

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)

0.0

TAF

Preliminary 1

data

43

110

53

Washington

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)

14.6

TAF

Preliminary 1

data

43

92

53

Washington

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

98.9

TAF

Preliminary 1

data

43

88

53

Washington

Linking Across Files

Linking Beneficiaries to Managed Care Plans

2023

Low concern

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

100.0

TAF

Preliminary 1

data

43

7

53

Washington

Enrollment Benchmarking

Total Medicaid and CHIP Enrollment

2023

Low concern

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

1.2

TAF

Preliminary 1

data

43

8

53

Washington

Enrollment Benchmarking

Medicaid-Only Enrollment

2023

Low concern

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

1.7

TAF

Preliminary 1

data

43

4

53

Washington

Enrollment Benchmarking

M-CHIP and S-CHIP Enrollment

2023

Low concern

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

0.2

TAF

Preliminary 1

data

43

9

53

Washington

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

53

Washington

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

Missing benchmark data

TAF

Preliminary 1

data

43

2

53

Washington

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

53

Washington

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

Missing benchmark data

TAF

Preliminary 1

data

43

5

53

Washington

Enrollment Benchmarking

Adult Expansion Enrollment

2023

Low 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

1.0

TAF

Preliminary 1

data

43

6

53

Washington

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

1.3

TAF

Preliminary 1

data

43

82

53

Washington

Enrollment Benchmarking

1915(c) Participation

2023

Low concern

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

53

Washington

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

53

Washington

Enrollment Benchmarking

1115 Demonstration Identification

2023

High concern

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

53

Washington

Enrollment Patterns Over Time

Number of Enrollment Spans

2023

Low 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

53

Washington

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

53

Washington

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

53

Washington

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

53

Washington

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

53

Washington

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

53

Washington

Beneficiary Information

Income

2023

Low concern

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

0.5

TAF

Preliminary 1

data

43

15

53

Washington

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

53

Washington

Beneficiary Information

Eligibility Group Code

2023

Medium concern

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

53

Washington

Beneficiary Information

Dual Eligibility Code

2023

Low concern

Multiple criteria: See Background and Methods

See Background and Methods

TAF

Preliminary 1

data

43

19

53

Washington

Beneficiary Information

CHIP Code

2023

Low concern

Multiple criteria: See Background and Methods

See Background and Methods

TAF

Preliminary 1

data

43

21

53

Washington

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)

99.1

TAF

Preliminary 1

data

43

119

53

Washington

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

53

Washington

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

53

Washington

Beneficiary Information

American Indian and Alaska Native Indicator

2023

Low concern

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

4.9

TAF

Preliminary 1

data

43

45

53

Washington

Claim Files Completeness

Claims Volume - IP

2023

Low 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

53

Washington

Claim Files Completeness

Claims Volume - LT

2023

Low concern

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)

84.3

TAF

Preliminary 1

data

43

47

53

Washington

Claim Files Completeness

Claims Volume - OT

2023

Low 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

53

Washington

Claim Files Completeness

Claims Volume - RX

2023

Low 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

53

Washington

Claim Files Completeness

Service Users - IP

2023

Low 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

78.7

TAF

Preliminary 1

data

43

28

53

Washington

Claim Files Completeness

Service Users - OT

2023

Low 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

100.3

TAF

Preliminary 1

data

43

29

53

Washington

Claim Files Completeness

Service Users - RX

2023

Low 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

99.8

TAF

Preliminary 1

data

43

121

53

Washington

Claim Files Completeness

Availability of CMC Plan Encounter Data

2023

Low concern

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

53

Washington

Claim Files Completeness

CMC Plan Encounters - IP

2023

Medium concern

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

53

Washington

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

53

Washington

Claim Files Completeness

CMC Plan Encounters - OT

2023

Medium concern

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

53

Washington

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

53

Washington

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

53

Washington

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

-41.5

TAF

Preliminary 1

data

43

87

53

Washington

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

-41.7

TAF

Preliminary 1

data

43

67

53

Washington

Expenditure Benchmarking

Total FFS Expenditures

2023

Medium concern

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

-11.0

TAF

Preliminary 1

data

43

68

53

Washington

Expenditure Benchmarking

FFS Inpatient Expenditures

2023

Medium concern

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

-7.5

TAF

Preliminary 1

data

43

69

53

Washington

Expenditure Benchmarking

FFS Long-Term Care Expenditures

2023

Medium concern

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

-17.6

TAF

Preliminary 1

data

43

70

53

Washington

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

-9.6

TAF

Preliminary 1

data

43

71

53

Washington

Expenditure Benchmarking

FFS Prescription Drug Expenditures

2023

High concern

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

-28.5

TAF

Preliminary 1

data

43

72

53

Washington

Expenditure Benchmarking

Total Monthly Beneficiary Payments

2023

Unusable

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

-56.0

TAF

Preliminary 1

data

43

73

53

Washington

Expenditure Benchmarking

CMC Payments

2023

Unusable

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

-53.4

TAF

Preliminary 1