Key Information

Measure Name	# of claim headers with TYPE-OF-CLAIM = U, V, W, X or Y that aren’t MFP (PROGRAM-TYPE = 08)
File Type	CLT
Measure ID	ALL-18-002-2
Measure Type	Count
Content area	ALL

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	High
Focus Area	N/A
Category	Expenditures

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

Data Elements

DD Data Element	TYPE-OF-CLAIM • PROGRAM-TYPE
DD Data Element Number	CLT052 • CLT079

Annotation

Count the number of paid LT claim headers for TYPE-OF-CLAIM = U, V, W, X, Y that aren't MFP

Specification

STEP 1: Active non-duplicate LT claims during DQ report month Define the LT 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 6. No Header Duplicates: Duplicates are dropped at the header-level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND. STEP 2: Count "other" claims that aren't MFP Of the claims that meet the criteria from STEP 1, count the number of claims that satisfy the following criteria: 1. TYPE-OF-CLAIM = "U" or "V" or "W" or "X" or "Y" 2. PROGRAM-TYPE is not equal to "08" or is missing