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Measure Name | # of Medicaid service tracking claim headers (TYPE-OF-CLAIM = 4) |
---|---|
File Type | COT |
Measure ID | ALL-27-001-1 |
Measure Type | Count |
Content area | ALL |
Validation Type | Inferential |
---|
Measure Priority | High |
---|---|
Focus Area | N/A |
Category | Expenditures |
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 |
Minimum | 5 |
---|---|
Maximum | N/A |
TA Minimun | 5 |
TA Maximum | |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | TYPE-OF-CLAIM |
---|---|
DD Data Element Number | COT037 |
Annotation | Count the number of Medicaid service tracking claims |
---|---|
Specification |
STEP 1: Active non-duplicate paid OT claims during report month Define the OT claims universe at the header level that satisfy the following criteria: 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. STEP 2: Medicaid Service Tracking Claims Of the claims that meet the criteria from STEP 1, count the number that meet the following criteria: 1. TYPE-OF-CLAIM = "4" |