Key Information

Measure Name	% of duplicate claim headers
File Type	CRX
Measure ID	ALL-5-004-4
Measure Type	Duplicate 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 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
DD Data Element Number

Annotation

Calculate the percentage of unique RX claim header records that appear more than once

Specification

STEP 1: Active RX claims during DQ report month Define the RX 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: Total Count From the records in STEP 1, count the number of unique header records. A unique header record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND. STEP 3: Count duplicates From the records in STEP 1, count unique header records that appear more than once STEP 4: Percentage Divide the count of unique header records from STEP 3 by the count in STEP 2