Official websites use .gov
A
.gov website belongs to an official government
organization in the United States.
Secure .gov websites use HTTPS
A
lock () or https:// means you've safely connected to
the .gov website. Share sensitive information only on official,
secure websites.
Measure Name | % of claim headers with missing Days Supply |
---|---|
File Type | CRX |
Measure ID | FFS-16-005-1 |
Measure Type | Claims Percentage |
Content area | FFS |
Validation Type | Longitudinal and Inferential |
---|
Measure Priority | N/A |
---|---|
Focus Area | N/A |
Category | N/A |
Claim Type | CHIP,FFS |
---|---|
Adjustment Type | Original |
Crossover Type | Non-Crossover |
Minimum | 0 |
---|---|
Maximum | 0.05 |
TA Minimun | |
TA Maximum | |
Longitudinal Threshold | 0.1 |
For TA
(for including in compliance training) |
No |
For TA
(Longitudinal) |
No |
DD Data Element | DAYS-SUPPLY |
---|---|
DD Data Element Number | CRX138 |
Annotation | Percentage of S-CHIP Encounter: original, non-crossover, paid RX claims with missing days supply |
---|---|
Specification |
STEP 1: Active non-duplicate paid RX claims during report month Define the RX claims universe at the header level by importing both headers and lines that satisfy the following criteria: For Headers: 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. For Lines: 1. Reporting Period from the filename = DQ report month 2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing 3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND. 4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-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: Prescription supply days Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. DAYS-SUPPLY is missing STEP 4: Calculate the percentage for the measure Divide the count of claims from STEP 3 by the count of claims from STEP 2 |