ALL-20-001-1

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

ALL-20-001-1

Data Quality Measure

Last updated

Key Information

Measure Name	% of claim lines with both XIX and XXI MBESCBES Category of Service
File Type	CIP
Measure ID	ALL-20-001-1
Measure Type	Claims Percentage
Content area	ALL

Validation

Validation Type	Inferential

Measure Priority

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

Claim Information

Claim Type	Medicaid,FFS or CHIP,FFS
Adjustment Type	Original and Replacement
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	XIX-MBESCBES-CATEGORY-OF-SERVICE • XXI-MBESCBES-CATEGORY-OF-SERVICE
DD Data Element Number	CIP270 • CIP271

Annotation

Calculate the percentage of Medicaid and S-CHIP FFS: original and replacement, paid IP claim lines indicating federal funding under both Title XIX (Medicaid) and Title XXI (S-CHIP)

Specification

STEP 1: Active non-duplicate IP records during DQ report month

Define the IP records universe at the line level by importing lines that satisfy the following criteria:

For Headers:

1. Reporting Period from 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.

For Lines:

1. Reporting Period from the filename = DQ report month

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

3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.

4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.

STEP 2: Medicaid and S-CHIP FFS: Original and Replacement Paid Claims

Of the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:

1. TYPE-OF-CLAIM = "1" or "A"

2. ADJUSTMENT-IND = "0" or "4"

STEP 3: Title XIX and Title XXI funding

Of the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria:

1. XIX-MBESCBES-CATEGORY-OF-SERVICE is not missing

2. XXI-MBESCBES-CATEGORY-OF-SERVICE is not missing

STEP 4: Calculate percentage

Divide the count of claim lines from STEP 3 by the count of claim lines from STEP 2

Published Date	Data Guide Version	DQM	Action	Field	Before	After
06/02/2023	3.8.0	ALL-20-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. 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.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: STEP 3: Title XIX and Title XXI fundingOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. XIX-MBESCBES-CATEGORY-OF-SERVICE is not missing2. XXI-MBESCBES-CATEGORY-OF-SERVICE is not missingSTEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records universe at the line level by importing lines that satisfy the following criteria:For Headers:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. 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.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 2: Medicaid and S-CHIP FFS: Original and Replacement Paid ClaimsOf the claim lines that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Title XIX and Title XXI fundingOf the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. XIX-MBESCBES-CATEGORY-OF-SERVICE is not missing2. XXI-MBESCBES-CATEGORY-OF-SERVICE is not missingSTEP 4: Calculate percentageDivide the count of claim lines from STEP 3 by the count of claim lines from STEP 2