rowType
stringclasses 2
values | tafVersionId
int64 6
43
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float64 1
124
⌀ | stateId
float64 1
78
⌀ | col0
stringclasses 57
values | col1
stringclasses 13
values | col2
stringclasses 121
values | col3
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values |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
data
| 43
| 47
| 54
|
West Virginia
|
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
| 54
|
West Virginia
|
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
| 54
|
West Virginia
|
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
|
89.7
|
TAF
|
Preliminary 1
|
data
| 43
| 28
| 54
|
West Virginia
|
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
|
104.7
|
TAF
|
Preliminary 1
|
data
| 43
| 29
| 54
|
West Virginia
|
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
|
121.1
|
TAF
|
Preliminary 1
|
data
| 43
| 121
| 54
|
West Virginia
|
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
| 54
|
West Virginia
|
Claim Files Completeness
|
CMC Plan Encounters - IP
|
2023
|
Low 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
| 54
|
West Virginia
|
Claim Files Completeness
|
CMC Plan Encounters - LT
|
2023
|
Low concern
|
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
| 54
|
West Virginia
|
Claim Files Completeness
|
CMC Plan Encounters - OT
|
2023
|
Low 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
| 54
|
West Virginia
|
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
| 54
|
West Virginia
|
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
| 54
|
West Virginia
|
Expenditure Benchmarking
|
Total Medicaid Expenditures
|
2023
|
Low concern
|
Percent difference in total Medicaid expenditures for medical assistance programs between the T-MSIS Analytic Files (TAF) and the CMS-64 data
|
-0.3
|
TAF
|
Preliminary 1
|
data
| 43
| 87
| 54
|
West Virginia
|
Expenditure Benchmarking
|
Medicaid Beneficiary Expenditures
|
2023
|
Medium concern
|
Percent difference in Medicaid beneficiary expenditures between the T-MSIS Analytic Files (TAF) and the CMS-64 data
|
-10.3
|
TAF
|
Preliminary 1
|
data
| 43
| 67
| 54
|
West Virginia
|
Expenditure Benchmarking
|
Total FFS Expenditures
|
2023
|
Low concern
|
Percent difference in Medicaid fee-for-service (FFS) expenditures between the T-MSIS Analytic Files (TAF) and the CMS-64 data
|
-4.6
|
TAF
|
Preliminary 1
|
data
| 43
| 68
| 54
|
West Virginia
|
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
|
-7.6
|
TAF
|
Preliminary 1
|
data
| 43
| 69
| 54
|
West Virginia
|
Expenditure Benchmarking
|
FFS Long-Term Care Expenditures
|
2023
|
Low 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
|
-4.7
|
TAF
|
Preliminary 1
|
data
| 43
| 70
| 54
|
West Virginia
|
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
|
-6.1
|
TAF
|
Preliminary 1
|
data
| 43
| 71
| 54
|
West Virginia
|
Expenditure Benchmarking
|
FFS Prescription Drug Expenditures
|
2023
|
Low 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
|
-2.7
|
TAF
|
Preliminary 1
|
data
| 43
| 72
| 54
|
West Virginia
|
Expenditure Benchmarking
|
Total Monthly Beneficiary Payments
|
2023
|
Medium concern
|
Percent difference in total monthly Medicaid beneficiary payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data
|
-17.5
|
TAF
|
Preliminary 1
|
data
| 43
| 73
| 54
|
West Virginia
|
Expenditure Benchmarking
|
CMC Payments
|
2023
|
Medium concern
|
Percent difference in comprehensive managed care (CMC) capitation payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data
|
-19.5
|
TAF
|
Preliminary 1
|
data
| 43
| 74
| 54
|
West Virginia
|
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
| 54
|
West Virginia
|
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
| 54
|
West Virginia
|
Expenditure Benchmarking
|
Premium Assistance Payments
|
2023
|
Unusable
|
Percent difference in premium assistance payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data
|
-100.0
|
TAF
|
Preliminary 1
|
data
| 43
| 66
| 54
|
West Virginia
|
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)
|
0.5
|
TAF
|
Preliminary 1
|
data
| 43
| 86
| 54
|
West Virginia
|
Payments
|
Missing Payment Data - Encounters
|
2023
|
Medium concern
|
Percentage of managed care (MC) encounters with a zero, missing, or negative payment amount in the T-MSIS Analytic Files (TAF)
|
12.6
|
TAF
|
Preliminary 1
|
data
| 43
| 101
| 54
|
West Virginia
|
Payments
|
Bundled Payments for Prenatal Care
|
2023
|
Low concern
|
Percent of deliveries with bundled payment code including prenatal care in the T-MSIS Analytic Files (TAF)
|
4.5
|
TAF
|
Preliminary 1
|
data
| 43
| 81
| 54
|
West Virginia
|
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
| 54
|
West Virginia
|
Payments
|
Payment Data Consistency - LT
|
2023
|
Low concern
|
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
| 54
|
West Virginia
|
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
| 54
|
West Virginia
|
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
| 54
|
West Virginia
|
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
|
99.2
|
TAF
|
Preliminary 1
|
data
| 43
| 112
| 54
|
West Virginia
|
Financial Reporting
|
Category of Service Code - LT
|
2023
|
Low concern
|
Percentage of LT lines that have a category of service code consistent with program enrollment
|
100.0
|
TAF
|
Preliminary 1
|
data
| 43
| 113
| 54
|
West Virginia
|
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
|
95.6
|
TAF
|
Preliminary 1
|
data
| 43
| 114
| 54
|
West Virginia
|
Financial Reporting
|
Category of Service Code - RX
|
2023
|
Medium concern
|
Percentage of RX lines that have a category of service code consistent with program enrollment
|
89.5
|
TAF
|
Preliminary 1
|
data
| 43
| 115
| 54
|
West Virginia
|
Financial Reporting
|
Federal Reimbursement Category Code - IP
|
2023
|
Low concern
|
Percentage of IP lines that have a federal reimbursement category consistent with program enrollment
|
99.1
|
TAF
|
Preliminary 1
|
data
| 43
| 116
| 54
|
West Virginia
|
Financial Reporting
|
Federal Reimbursement Category Code - LT
|
2023
|
Low concern
|
Percentage of LT lines that have a federal reimbursement category consistent with program enrollment
|
100.0
|
TAF
|
Preliminary 1
|
data
| 43
| 117
| 54
|
West Virginia
|
Financial Reporting
|
Federal Reimbursement Category Code - OT
|
2023
|
Low concern
|
Percentage of OT lines that have a federal reimbursement category consistent with program enrollment
|
97.3
|
TAF
|
Preliminary 1
|
data
| 43
| 118
| 54
|
West Virginia
|
Financial Reporting
|
Federal Reimbursement Category Code - RX
|
2023
|
Low concern
|
Percentage of RX lines that have a federal reimbursement category consistent with program enrollment
|
98.5
|
TAF
|
Preliminary 1
|
data
| 43
| 49
| 54
|
West Virginia
|
Service Use Information
|
Diagnosis Code - IP
|
2023
|
Medium concern
|
Percentage of inpatient (IP) header records with a valid ICD-10 primary diagnosis code in the T-MSIS Analytic Files (TAF)
|
89.1
|
TAF
|
Preliminary 1
|
data
| 43
| 50
| 54
|
West Virginia
|
Service Use Information
|
Diagnosis Code - LT
|
2023
|
Low concern
|
Percentage of long-term care (LT) header records with a valid ICD-10 primary diagnosis code in the T-MSIS Analytic Files (TAF)
|
93.1
|
TAF
|
Preliminary 1
|
data
| 43
| 51
| 54
|
West 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)
|
96.1
|
TAF
|
Preliminary 1
|
data
| 43
| 65
| 54
|
West 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
| 54
|
West 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)
|
0.8
|
TAF
|
Preliminary 1
|
data
| 43
| 64
| 54
|
West 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)
|
2.7
|
TAF
|
Preliminary 1
|
data
| 43
| 52
| 54
|
West 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
| 54
|
West 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
| 54
|
West 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
| 54
|
West 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
| 54
|
West 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)
|
100.0
|
TAF
|
Preliminary 1
|
data
| 43
| 41
| 54
|
West 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
| 54
|
West 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)
|
0.1
|
TAF
|
Preliminary 1
|
data
| 43
| 43
| 54
|
West 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
| 54
|
West 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
| 54
|
West 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)
|
99.9
|
TAF
|
Preliminary 1
|
data
| 43
| 24
| 54
|
West 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)
|
98.5
|
TAF
|
Preliminary 1
|
data
| 43
| 25
| 54
|
West 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
| 54
|
West 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
| 54
|
West 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)
|
4.7
|
TAF
|
Preliminary 1
|
data
| 43
| 90
| 54
|
West 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
| 54
|
West Virginia
|
Non-Claim Records
|
Supplemental Payments
|
2023
|
Unclassified
|
Multiple criteria: See Background and Methods
|
See Background and Methods
|
TAF
|
Preliminary 1
|
data
| 43
| 61
| 54
|
West 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
| 54
|
West 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
| 54
|
West 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
| 54
|
West 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
| 54
|
West 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)
|
5.3
|
TAF
|
Preliminary 1
|
data
| 43
| 36
| 54
|
West 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
| 54
|
West Virginia
|
Provider Information
|
Servicing Provider NPI - OT
|
2023
|
Medium concern
|
Percentage of other service (OT) line records with a missing servicing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF)
|
10.1
|
TAF
|
Preliminary 1
|
data
| 43
| 31
| 54
|
West 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
| 54
|
West 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
| 54
|
West 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)
|
100.0
|
TAF
|
Preliminary 1
|
data
| 43
| 38
| 54
|
West 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)
|
99.3
|
TAF
|
Preliminary 1
|
data
| 43
| 104
| 54
|
West 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)
|
96.9
|
TAF
|
Preliminary 1
|
data
| 43
| 105
| 54
|
West 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)
|
99.7
|
TAF
|
Preliminary 1
|
data
| 43
| 103
| 54
|
West Virginia
|
Provider Information
|
Billing Provider Specialty and Taxonomy - RX
|
2023
|
Low concern
|
Percentage of RX header records with an expected billing provider specialty or taxonomy code
|
100.0
|
TAF
|
Preliminary 1
|
data
| 43
| 106
| 54
|
West 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)
|
92.0
|
TAF
|
Preliminary 1
|
data
| 43
| 107
| 54
|
West 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)
|
99.7
|
TAF
|
Preliminary 1
|
data
| 43
| 26
| 54
|
West Virginia
|
Provider Information
|
Hospital Type - IP
|
2023
|
Low concern
|
Percentage of inpatient (IP) claim header records with an expected type of hospital code in the T-MSIS Analytic Files (TAF)
|
100.0
|
TAF
|
Preliminary 1
|
data
| 43
| 91
| 54
|
West 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)
|
61.5
|
TAF
|
Preliminary 1
|
data
| 43
| 94
| 54
|
West 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
| 54
|
West 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)
|
99.9
|
TAF
|
Preliminary 1
|
data
| 43
| 97
| 54
|
West 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)
|
98.0
|
TAF
|
Preliminary 1
|
data
| 43
| 96
| 54
|
West 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
| 54
|
West Virginia
|
Provider Information
|
Provider Location
|
2023
|
Low concern
|
Percentage of participating providers without a usable service or practice location: ZIP code or county code
|
0.6
|
TAF
|
Preliminary 1
|
data
| 43
| 109
| 54
|
West Virginia
|
Provider Information
|
National Provider Identifier
|
2023
|
Medium concern
|
Percentage of TAF Annual Provider Files (APR) records with a valid NPI
|
87.1
|
TAF
|
Preliminary 1
|
data
| 43
| 98
| 54
|
West 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)
|
28.6
|
TAF
|
Preliminary 1
|
data
| 43
| 99
| 54
|
West 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)
|
42.9
|
TAF
|
Preliminary 1
|
data
| 43
| 100
| 54
|
West 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
| 55
|
Wisconsin
|
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)
|
0.8
|
TAF
|
Preliminary 1
|
data
| 43
| 110
| 55
|
Wisconsin
|
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)
|
10.3
|
TAF
|
Preliminary 1
|
data
| 43
| 92
| 55
|
Wisconsin
|
Linking Across Files
|
Linking Claims to Providers
|
2023
|
High 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
|
76.4
|
TAF
|
Preliminary 1
|
data
| 43
| 88
| 55
|
Wisconsin
|
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
| 55
|
Wisconsin
|
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
|
4.0
|
TAF
|
Preliminary 1
|
data
| 43
| 8
| 55
|
Wisconsin
|
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
|
4.0
|
TAF
|
Preliminary 1
|
data
| 43
| 4
| 55
|
Wisconsin
|
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
|
3.3
|
TAF
|
Preliminary 1
|
data
| 43
| 9
| 55
|
Wisconsin
|
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
| 55
|
Wisconsin
|
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
| 55
|
Wisconsin
|
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
| 55
|
Wisconsin
|
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
| 55
|
Wisconsin
|
Enrollment Benchmarking
|
Adult Expansion Enrollment
|
2023
|
Unclassified
|
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
|
Not applicable
|
TAF
|
Preliminary 1
|
data
| 43
| 6
| 55
|
Wisconsin
|
Enrollment Benchmarking
|
Newly Eligible Adult Enrollment
|
2023
|
Unclassified
|
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
|
Not applicable
|
TAF
|
Preliminary 1
|
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