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SAS Name
EL_MDCR_DUAL_MO_<1-12>
CODE INDICATING THAT THE ELIGIBLE IS COVERED BY MEDICARE (KNOWN AS DUAL OR MEDICARE ELIGIBILITY), ACCORDING TO MEDICAID (MSIS), MEDICARE (EDB) OR BOTH FOR THE RESPECTIVE MONTH.
NOTES: IN MAX 2005, THIS VARIABLE WAS ADDED TO THE FILE. IN MAX 2006, VALUES 50-59 WERE ADDED TO THE FILE.
NOTE: IN MAX 2006, VALUES 50-59 WERE ADDED TO THE FILE.
NOTE: IN MAX 2009, VALUES 10 AND 60 WERE ADDED TO THE FILE.
Data Variable Alert:
CMS has identified an error in the 2008 MAX Personal Summary file for North Carolina. Researchers who recieved the file prior to 9/13/13 will need to apply the correction to the data. Files received after 9/13/13 will have been corrected.
Two undocumented values were discovered for the monthly dual codes (EL_MDCR_DUAL_MO_x, where x = 1-12) in North Carolina's MAX 2008 Personal Summary (PS) file. The undocumented values were "5 " (5 space) and " " (space space). CMS researched the issue and determined that the correct values should be "50" and "00", respectively. The annual dual code (EL_MDCR_DUAL_ANN) and the validation tables (which use the annual dual code) are unaffected by the error.
CMS regrets any the inconvenience this may have caused for the user community. Researchers can fix the error themselves, by recoding "5 " (5 space) to "50" (5 zero) and recoding " " (space space) to "00" (zero zero).
USER NOTE: THIS DATA ELEMENT IS EQUAL TO THE MSIS DATA ELEMENT 'DUAL-ELIGIBLE-CODE' (I.E. VALUES 00-09). IF THE PERSON IS
ELIGIBLE FOR MEDICAID AND ENROLLED IN THE MEDICARE ENROLLMENT DATA BASE (EDB) IN THE SAME MONTH, A '5' IS MOVED TO
THE FIRST POSITION (I.E. VALUES 50-59). IF THE PERSON HAS CLAIMS BUT NO ELIGIBILITY RECORD, THE VALUE IS SET TO 99.
ELIGIBLE FOR MEDICAID AND ENROLLED IN THE MEDICARE ENROLLMENT DATA BASE (EDB) IN THE SAME MONTH, A '5' IS MOVED TO
THE FIRST POSITION (I.E. VALUES 50-59). IF THE PERSON HAS CLAIMS BUT NO ELIGIBILITY RECORD, THE VALUE IS SET TO 99.
| Code | Code value |
|---|---|
| 00 | IN MSIS, ELIGIBLE IS NOT A MEDICARE BENEFICIARY |
| 01 | IN MSIS, ELIGIBLE IS ENTITLED TO MEDICARE-QMB ONLY |
| 02 | IN MSIS, ELIGIBLE IS ENTITLED TO MEDICARE-QMB AND FULL MEDICAID COVERAGE |
| 03 | IN MSIS, ELIGIBLE IS ENTITLED TO MEDICARE-SLMB ONLY |
| 04 | IN MSIS, ELIGIBLE IS ENTITLED TO MEDICARE-SLMB AND FULL MEDICAID COVERAGE |
| 05 | IN MSIS, ELIGIBLE IS ENTITLED TO MEDICARE-QDWI |
| 06 | IN MSIS, ELIGIBLE IS ENTITLED TO MEDICARE-QUALIFYING INDIVIDUALS (1) |
| 07 | IN MSIS, ELIGIBLE IS ENTITLED TO MEDICARE-QUALIFYING INDIVIDUALS (2) |
| 08 | IN MSIS, ELIGIBLE IS ENTITLED TO MEDICARE-OTHER DUAL ELIGIBLES |
| 09 | IN MSIS, ELIGIBLE IS ENTITLED TO MEDICARE-DUAL ELIGIBILITY CATEGORY UNKNOWN |
| 10 | IN MSIS, S-CHIP ELIGIBLE IS ENTITLED TO MEDICARE |
| 50 | A RECORD WAS FOUND IN THE MEDICARE ENROLLMENT DATA BASE (EDB) FOR THE ELIGIBLE AND CODES 01-09 DO NOT APPLY |
| 51 | A RECORD WAS FOUND IN THE MEDICARE ENROLLMENT DATA BASE (EDB) FOR THE ELIGIBLE AND CODE 01 APPLIES |
| 52 | A RECORD WAS FOUND IN THE MEDICARE ENROLLMENT DATA BASE (EDB) FOR THE ELIGIBLE AND CODE 02 APPLIES |
| 53 | A RECORD WAS FOUND IN THE MEDICARE ENROLLMENT DATA BASE (EDB) FOR THE ELIGIBLE AND CODE 03 APPLIES |
| 54 | A RECORD WAS FOUND IN THE MEDICARE ENROLLMENT DATA BASE (EDB) FOR THE ELIGIBLE AND CODE 04 APPLIES |
| 55 | A RECORD WAS FOUND IN THE MEDICARE ENROLLMENT DATA BASE (EDB) FOR THE ELIGIBLE AND CODE 05 APPLIES |
| 56 | A RECORD WAS FOUND IN THE MEDICARE ENROLLMENT DATA BASE (EDB) FOR THE ELIGIBLE AND CODE 06 APPLIES |
| 57 | A RECORD WAS FOUND IN THE MEDICARE ENROLLMENT DATA BASE (EDB) FOR THE ELIGIBLE AND CODE 07 APPLIES |
| 58 | A RECORD WAS FOUND IN THE MEDICARE ENROLLMENT DATA BASE (EDB) FOR THE ELIGIBLE AND CODE 08 APPLIES |
| 59 | A RECORD WAS FOUND IN THE MEDICARE ENROLLMENT DATA BASE (EDB) FOR THE ELIGIBLE AND CODE 09 APPLIES |
| 60 | A RECORD WAS FOUND IN THE MEDICARE ENROLLMENT DATA BASE (EDB) FOR THE S-CHIP ELIGIBLE AND CODE 10 APPLIES |
| 99 | IN MSIS, ELIGIBLE'S MEDICARE STATUS IS UNKNOWN |
USER NOTE: THIS DATA ELEMENT IS EQUAL TO THE MSIS DATA ELEMENT 'DUAL-ELIGIBLE-CODE' (I.E. VALUES 00-09). IF THE PERSON IS ELIGIBLE FOR MEDICAID AND ENROLLED IN THE MEDICARE ENROLLMENT DATA BASE (EDB) IN THE SAME MONTH, A '5' IS MOVED TO THE FIRST POSITION (I.E. VALUES 50-59). IF THE PERSON HAS CLAIMS BUT NO ELIGIBILITY RECORD, THE VALUE IS SET TO 99.