Managed care combinations (Dec)

SAS Name
MC_COMBO_MO_12

CODE INDICATING THE TYPES OF MANAGED CARE THE ELIGIBLE WAS ENROLLED IN FOR THE RESPECTIVE MONTH.

Comments

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'.

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