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Measure Name | % of header claims with Total Medicaid Paid Amount = $0 or missing |
---|---|
File Type | COT |
Measure ID | EXP-45-003-3 |
Measure Type | Claims Percentage |
Content area | EXP |
Validation Type | Inferential |
---|
Measure Priority | N/A |
---|---|
Focus Area | N/A |
Category | N/A |
Claim Type | Medicaid,Supp or CHIP,Supp |
---|---|
Adjustment Type | All Adjustment Types |
Crossover Type | All Indicators |
Minimum | 0 |
---|---|
Maximum | 0.1 |
TA Minimun | |
TA Maximum | |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
No |
For TA
(Longitudinal) |
No |
DD Data Element | TOT-MEDICAID-PAID-AMT |
---|---|
DD Data Element Number | COT050 |
Annotation | Calculate the percentage of Medicaid and S-CHIP supplemental, original and adjustment, paid OT claims that have a non zero Total Medicaid Paid Amount |
---|---|
Specification |
STEP 1: Active non-duplicate paid OT claims during report month Define the OT 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 and S-CHIP Supplemental: Original and Adjustment, Paid Claims Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria: 1. TYPE-OF-CLAIM = "5" or "E" STEP 3: Total Medicaid Paid Amount Zero or Missing Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TOT-MEDICAID-PAID-AMT = "0" or is missing STEP 4: Calculate percentage Divide the count of claims from STEP 3 by the count from STEP 2 |