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Measure Name | Sum of Total Medicaid Paid Amount |
---|---|
File Type | CIP |
Measure ID | EXP-3-001-5 |
Measure Type | Sum |
Content area | EXP |
Validation Type | Longitudinal |
---|
Measure Priority | Medium |
---|---|
Focus Area | N/A |
Category | Expenditures |
Claim Type | CHIP,FFS |
---|---|
Adjustment Type | Original |
Crossover Type | Non-Crossover |
Minimum | N/A |
---|---|
Maximum | N/A |
TA Minimun | |
TA Maximum | |
Longitudinal Threshold | 0.5 |
For TA
(for including in compliance training) |
TA- Longitudinal |
For TA
(Longitudinal) |
Yes |
DD Data Element | TOT-MEDICAID-PAID-AMT |
---|---|
DD Data Element Number | CIP114 |
Annotation | Calculate the sum of the total Medicaid amount paid for S-CHIP FFS: original, non-crossover, paid IP claims |
---|---|
Specification |
STEP 1: Active non-duplicate IP claims during DQ report month Define the IP 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 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: S-CHIP FFS: 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 = "A" 2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missing STEP 3: Sum the total Medicaid paid amount Sum the TOT-MEDICAID-PAID-AMT of the records which meet the criteria from STEP 2 |