Updated research request forms and data security approval requirement effective 4/24/23
SAS Name
MC_COMBO_MO_12
CODE INDICATING THE TYPES OF MANAGED CARE THE ELIGIBLE WAS ENROLLED IN FOR THE RESPECTIVE MONTH.
THE FOLLOWING IS HOW MSIS DATA ELEMENTS PLAN-TYPE-1 TO PLAN-TYPE-4 ARE MAPPED INTO THE CODE VALUES FOR THIS DATA ELEMENT:
THE FOLLOWING IS HOW MSIS DATA ELEMENTS PLAN-TYPE-1 TO PLAN-TYPE-4 ARE MAPPED INTO THE CODE VALUES FOR THIS DATA ELEMENT:
Code | Code value |
---|---|
00 | 00 IN ALL FOUR PLAN TYPES THIS MONTH - PERSON WAS NOT ELIGIBLE FOR MEDICAID THIS MONTH |
01 | 01 ELIGIBLE IS ENROLLED IN A MEDICAL OR COMPREHENSIVE MANAGED CARE PLAN THIS MONTH (E.G. HMO), AND NO OTHER TYPE OF PLAN |
02 | 02 ELIGIBLE IS ENROLLED IN A DENTAL MANAGED CARE PLAN THIS MONTH, AND NO OTHER TYPE OF PLAN |
03 | 03 ELIGIBLE IS ENROLLED IN A BEHAVIORAL MANAGED CARE PLAN THIS MONTH, AND NO OTHER TYPE OF PLAN |
04 | 07 ELIGIBLE IS ENROLLED IN A PRIMARY CARE CASE MANAGEMENT MANAGED CARE PLAN THIS MONTH, AND NO OTHER TYPE OF PLAN |
05 | 04 ELIGIBLE IS ENROLLED IN A PRENATAL/DELIVERY MANAGED CARE PLAN THIS MONTH, OR |
05 | 05 ELIGIBLE IS ENROLLED IN A LONG-TERM CARE MANAGED CARE PLAN THIS MONTH, OR |
05 | 06 ELIGIBLE IS ENROLLED IN A PROGRAM FOR ALL-INCLUSINVE CARE FOR THE ELDERLY (PACE) THIS MONTH, OR |
05 | 08 ELIGIBLE IS ENROLLED IN AN OTHER MANAGED CARE PLAN THIS MONTH, OR (ONE OR MORE OF THE MSIS CODES 04, 05, 06, 08 THIS MONTH) |
06 | 01 AND 02 |
07 | 01 AND 03 |
08 | 01 AND (ONE OR MORE OF THE MSIS CODES 04, 05, 06, 08 THIS MONTH) |
09 | 01 AND 02 AND 03 |
10 | 07 AND 02 |
11 | 07 AND 03 |
12 | 07 AND (ONE OR MORE OF THE MSIS CODES 04, 05, 06, 08 THIS MONTH) |
13 | 07 AND 02 AND 03 |
14 | 02 AND 03 |
15 | ALL OTHER COMBINATIONS OF MANAGED CARE PLAN CODES THIS MONTH (INCLUDING 99 AND ONE OR MORE OTHER MSIS CODES) |
16 | 88 IN ALL FOUR MSIS PLAN TYPES THIS MONTH - PERSON WAS ELIGIBLE THIS MONTH BUT NOT ENROLLED IN MANAGED CARE |
99 | 99 IN ALL FOUR MSIS PLAN TYPES THIS MONTH - ELIGIBLE'S MANAGED CARE PLAN STATUS IS UNKNOWN THIS MONTH |
00 | 00 IN ALL FOUR PLAN TYPES THIS MONTH - PERSON WAS NOT ELIGIBLE FOR MEDICAID THIS MONTH |
01 | 01 ELIGIBLE IS ENROLLED IN A MEDICAL OR COMPREHENSIVE MANAGED CARE PLAN THIS MONTH (E.G. HMO), AND NO OTHER TYPE OF PLAN |
02 | 02 ELIGIBLE IS ENROLLED IN A DENTAL MANAGED CARE PLAN THIS MONTH, AND NO OTHER TYPE OF PLAN |
03 | 03 ELIGIBLE IS ENROLLED IN A BEHAVIORAL MANAGED CARE PLAN THIS MONTH, AND NO OTHER TYPE OF PLAN |
04 | 07 ELIGIBLE IS ENROLLED IN A PRIMARY CARE CASE MANAGEMENT MANAGED CARE PLAN THIS MONTH, AND NO OTHER TYPE OF PLAN |
05 | 04 ELIGIBLE IS ENROLLED IN A PRENATAL/DELIVERY MANAGED CARE PLAN THIS MONTH, OR |
05 | 05 ELIGIBLE IS ENROLLED IN A LONG-TERM CARE MANAGED CARE PLAN THIS MONTH, OR |
05 | 06 ELIGIBLE IS ENROLLED IN A PROGRAM FOR ALL-INCLUSINVE CARE FOR THE ELDERLY (PACE) THIS MONTH, OR |
05 | 08 ELIGIBLE IS ENROLLED IN AN OTHER MANAGED CARE PLAN THIS MONTH, OR (ONE OR MORE OF THE MSIS CODES 04, 05, 06, 08 THIS MONTH) |
06 | 01 AND 02 |
07 | 01 AND 03 |
08 | 01 AND (ONE OR MORE OF THE MSIS CODES 04, 05, 06, 08 THIS MONTH) |
09 | 01 AND 02 AND 03 |
10 | 07 AND 02 |
11 | 07 AND 03 |
12 | 07 AND (ONE OR MORE OF THE MSIS CODES 04, 05, 06, 08 THIS MONTH) |
13 | 07 AND 02 AND 03 |
14 | 02 AND 03 |
15 | ALL OTHER COMBINATIONS OF MANAGED CARE PLAN CODES THIS MONTH (INCLUDING 99 AND ONE OR MORE OTHER MSIS CODES) |
16 | 88 IN ALL FOUR MSIS PLAN TYPES THIS MONTH - PERSON WAS ELIGIBLE THIS MONTH BUT NOT ENROLLED IN MANAGED CARE |
99 | 99 IN ALL FOUR MSIS PLAN TYPES THIS MONTH - ELIGIBLE'S MANAGED CARE PLAN STATUS IS UNKNOWN THIS MONTH |
USER NOTE: WHEN SOMEONE HAS CLAIMS BUT NO ELIGIBILITY INFORMATION, THIS DATA ELEMENT IS 0-FILLED.
NOTE: IN MAX 2008, A CLARIFICATION NOTE WAS ADDED ABOUT THE VALUE ASSIGNED WHEN SOMEONE HAS CLAIMS BUT NO ELIGIBILITY INFORMATION.
SOURCE: CREATED FROM MSIS ELIGIBILITY FILES USING 'PLAN-TYPE-1 TO -4'.