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Measure Name | % of duplicate claim lines |
---|---|
File Type | COT |
Measure ID | ALL-5-007-7 |
Measure Type | Duplicate percentage |
Content area | ALL |
Validation Type | Inferential |
---|
Measure Priority | N/A |
---|---|
Focus Area | N/A |
Category | N/A |
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 | 0 |
---|---|
Maximum | 0.001 |
TA Minimun | |
TA Maximum | |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
No |
For TA
(Longitudinal) |
No |
DD Data Element | |
---|---|
DD Data Element Number |
Annotation | Calculate the percentage of unique OT claim line records that appear more than once |
---|---|
Specification |
STEP 1: Active paid OT claims during DQ report month Define the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria: 1a. Limit to Report Month Reporting Period from the filename = DQ report month 1b. Join Headers and Lines Merge headers and lines using: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND, and keep all claims, including orphan lines 1c. Keep headers and associated lines if header is not denied; keep lines if header is missing (If header is denied also drop associated lines) 1. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing 2. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing 3. TYPE-OF-CLAIM is not equal to "Z" or is missing 4. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing 1d. Keep line if line is not denied 1. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing STEP 2: Total Count Of the claims that meet the criteria from STEP 1, count the number of unique line records. A unique line record is defined by distinct combinations of the following data elements: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND. STEP 3: Count duplicates From the records in STEP 1, count unique line records that appear more than once STEP 4: Percentage Divide the count of unique line records from STEP 3 by the count in STEP 2 |