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TMSIS Dataguide Medicaid.gov
Version 3.27.0

ALL-16-002-2

Data Quality Measure
Last updated

Key Information

Measure Name % of claim line record segments missing ADJUDICATION-DATE (CIP00003)
File Type CIP
Measure ID ALL-16-002-2
Measure Type Claims Percentage
Content area ALL MULTI MIS

Validation

Validation Type Inferential

Measure Priority

Measure Priority N/A
Focus Area N/A
Category N/A

Claim Information

Claim Type Medicaid,FFS or Medicaid,Cap or Medicaid,Enc or Medicaid,Serv or Medicaid,Supp or CHIP,FFS or CHIP,Cap or CHIP,Enc or CHIP,Serv or CHIP,Supp
Adjustment Type All Adjustment Types
Crossover Type All Indicators

Thresholds

Minimum 0
Maximum 0.001
TA Minimun
TA Maximum
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		No
For TA
(Longitudinal) 		No

Data Elements

DD Data Element ADJUDICATION-DATE
DD Data Element Number CIP286

Annotation Calculate the percentage of paid IP claim line record segments containing a missing value for adjudication date
Specification STEP 1: Active paid IP claims during DQ report month

Define the IP claims universe at the line level by importing both headers and lines that satisfy the following criteria:



1a. Limit to Report Month

Reporting Period from the filename = DQ report month



1b. Join Headers and Lines

Merge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, including orphan lines



1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines)

1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing

2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing

3. TYPE-OF-CLAIM is not equal to "Z" or is missing

4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing



1d. Keep line if line is not denied

1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing



STEP 2: Missing adjudication date

Of the claim lines that meet the criteria from STEP 2, select those where:

1. ADJUDICATION-DATE is missing



STEP 3: Calculate percentage

Divide the count of rows from STEP 2 by the count of rows from STEP 1