Key Information

Measure Name	% of claim header record segments missing ADJUDICATION-DATE (COT00002)
File Type	COT
Measure ID	ALL-16-005-5
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	COT035

Annotation

Calculate the percentage of paid OT claim header record segments containing a missing value for adjudication date

Specification

STEP 1: Active OT claims during DQ report month Define the OT claims universe at the header level that satisfy the following criteria: 1. Reporting Period for the filename = DQ report month 2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing 3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing 4. TYPE-OF-CLAIM is not equal to "Z" or is missing 5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing STEP 2: Missing adjudication date Of the claims 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