Medicaid Analytic eXtract Data: Utilization Data for Managed Care Enrollees

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.

• CMS MAX Data Validation Reports
  • Produced for each calendar year
  • Specific reports by MAX file type
  • information on the number of MCO enrollees
  • counts of encounter claims
• CMS Medicaid Issue Briefs
  • Assessment of research utility of reported encounter data
  • 2007-2011
  • Subsetted by state, file and eligibility group
• Kaiser Family Foundation State Health Fact tables for Medicaid
  • Non-CMS, non-MAX resource
  • MCO penetration rates by major eligibility group
  • Percentages of population in different delivery systems
  • Annual change in MCO enrollment

Descriptive information on Medicaid managed care plans is available.

• Definitions of Medicaid managed care entities or types of plans
• The CCW Technical Guidance document, Getting Started With CMS MAX Data Files