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Measure Name | Average Total Medicaid Paid Amount (excludes outliers with Total Medicaid Paid Amount > $2 million) |
---|---|
File Type | CIP |
Measure ID | EXP-1-013-4 |
Measure Type | Average |
Content area | EXP |
Validation Type | Longitudinal and Inferential |
---|
Measure Priority | Medium |
---|---|
Focus Area | N/A |
Category | Expenditures |
Claim Type | Medicaid,FFS |
---|---|
Adjustment Type | Original |
Crossover Type | Non-Crossover |
Minimum | 2000 |
---|---|
Maximum | 12000 |
TA Minimun | 1500 |
TA Maximum | 12000 |
Longitudinal Threshold | 0.15 |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | TOT-MEDICAID-PAID-AMT |
---|---|
DD Data Element Number | CIP114 |
Annotation | Calculate the average amount paid (excluding outliers with Medicaid Amount Paid > $2 million) for Medicaid FFS: original, non-crossover, paid IP claims |
---|---|
Specification |
STEP 1: Active non-duplicate paid IP claims during report month Define the IP 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 FFS Payment: Original, Non-Crossover, Paid Claims Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria: 1. TYPE-OF-CLAIM = "1" 2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missing STEP 3: Restrict claims with paid amounts less than $2,000,000 Of the records that meet the criteria from STEP 2, further restrict them to those with: 1. TOT-MEDICAID-PAID-AMT< 2,000,000 STEP 4: Average Of the records that meet the criteria in STEP 3, take the average of TOT-MEDICAID-PAID-AMT |