Medicaid Analytic eXtract Data: Utilization Data for Managed Care Enrollees

Medicaid Analytic eXtract Data: Utilization Data for Managed Care Enrollees

Current Version Date: 
01/26/2018
Purpose: 

This article provides resources for the assessment of the quantity and quality of managed care organization (MCO) encounter data in the Medicaid Analytic eXtract (MAX) files.

It is difficult to know, in advance of a data request, whether the utilization data available in the MAX data for managed care enrollees will be of adequate quantity or quality to support research analysis. This type of utilization data is referred to in MAX as “encounter data” and is recorded in records labelled as such. Use the Type of Claim variable to identify whether a record in MAX represents a FFS claim (value=1) or a MCO encounter record (value=3). This variable is found in each of the MAX utilization files: Inpatient, Other Therapy, Prescription Drug and Long Term Care.

The utility of encounter data for research analysis varies by state, enrollment group, file type, and/or year.

Researchers can use the following resources to assess the available encounter data in MAX before they have received the data.

Descriptive information on Medicaid managed care plans is available.

Article Number: 
51
Author(s): 
This work was performed under CMS Contract Number HHSM-500-2015-00558G
Related Data File Families: 
Related Data File Variables: 

Disclaimer

The process and materials mentioned as part of this KnowledgeBase article are current, as of the publication date on the article, to the best of our knowledge. The examples provided are correct in the aggregate but may not apply to every subgroup or circumstance that a researcher may wish to study. It is up to the researcher to conduct analysis and confirm that the patterns described in this KnowledgeBase article apply to his/her particular study. If your research findings appear to contradict the advice provided, please contact ResDAC at resdac@umn.edu.