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Measure Name | # of non-service tracking claim headers with non-missing Service Tracking Payment Amount |
---|---|
File Type | CRX |
Measure ID | EXP-43-008-8 |
Measure Type | Count |
Content area | EXP |
Validation Type | Inferential |
---|
Measure Priority | High |
---|---|
Focus Area | N/A |
Category | Expenditures |
Claim Type | N/A |
---|---|
Adjustment Type | All Adjustment Types |
Crossover Type | All Indicators |
Minimum | 0 |
---|---|
Maximum | 25 |
TA Minimun | 0 |
TA Maximum | 25 |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | TYPE-OF-CLAIM • SERVICE-TRACKING-PAYMENT-AMT |
---|---|
DD Data Element Number | CRX029 • CRX051 |
Annotation | Calculate the number of non-service tracking, paid RX claims with a non-missing service tracking payment amount |
---|---|
Specification |
STEP 1: Active non-duplicate RX records during DQ report month Define the RX records 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: Non-service tracking claims Of the claims that meet the criteria from STEP 1, count the number of claims that satisfy the following criteria: 1. TYPE-OF-CLAIM does not equal ("4", "D", or "X") STEP 3: Count claims with a non-missing service tracking payment amount Of the claims that meet the criteria from STEP 2, count the number of claims that satisfy the following criteria: 1. SERVICE-TRACKING-PAYMENT-AMT is not missing 2. SERVICE-TRACKING-PAYMENT-AMT does not equal "0" |