ALL-36-001-1

Data Quality Measure

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Key Information

Measure Name	# of service tracking claim lines with TYPE-OF-SERVICE = 123 (DSH), 131 (Drug Rebates), 135 (EHR)
File Type	Multiple Files
Measure ID	ALL-36-001-1
Measure Type	Count
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,Serv or CHIP,Serv
Adjustment Type	Non-void
Crossover Type	All Indicators

Thresholds

Minimum	N/A
Maximum	N/A
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	TYPE-OF-SERVICE • TYPE-OF-SERVICE • TYPE-OF-SERVICE
DD Data Element Number	CIP257 • COT186 • CRX134

Annotation	Count the number of Medicaid and S-CHIP Service Tracking: non-void paid IP, OT, and RX claim lines with type of service values indicating DSH, drug rebates, or EHR
Specification	STEP 1: Active non-duplicate paid IP claims during report month Define the IP claims universe at the line level by importing both headers and 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 Service Tracking: Non-void, Paid Claims Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria: 1. TYPE-OF-CLAIM = "4" or "D" 2. ADJUSTMENT-IND not equal to "1" STEP 3: DSH, Drug Rebates, or EHR type of service Of claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TYPE-OF-SERVICE = "123", "131", or "135" STEP 4: Repeat STEPS 1-3 for OT and RX STEP 5: Sum claims Sum the number of claim lines from the IP, OT, and RX files that meet all the criteria

Annotation

Count the number of Medicaid and S-CHIP Service Tracking: non-void paid IP, OT, and RX claim lines with type of service values indicating DSH, drug rebates, or EHR

Specification

STEP 1: Active non-duplicate paid IP claims during report month

Define the IP claims universe at the line level by importing both headers and 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 Service Tracking: Non-void, Paid Claims

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

1. TYPE-OF-CLAIM = "4" or "D"

2. ADJUSTMENT-IND not equal to "1"

STEP 3: DSH, Drug Rebates, or EHR type of service

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

1. TYPE-OF-SERVICE = "123", "131", or "135"

STEP 4: Repeat STEPS 1-3 for OT and RX

STEP 5: Sum claims

Sum the number of claim lines from the IP, OT, and RX files that meet all the criteria