Key Information

Measure Name	% of claim headers with home Patient Status
File Type	CLT
Measure ID	FFS-5-006-11
Measure Type	Claims Percentage
Content area	FFS

Validation

Validation Type	Longitudinal and Inferential

Measure Priority

Measure Priority	Medium
Focus Area	N/A
Category	Utilization

Claim Information

Claim Type	Medicaid,FFS
Adjustment Type	Original
Crossover Type	Non-Crossover

Thresholds

Minimum	0.0001
Maximum	0.05
TA Minimun	0.0001
TA Maximum	0.1
Longitudinal Threshold	0.1
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	PATIENT-STATUS
DD Data Element Number	CLT141

Annotation

Calculate the percentage of Medicaid FFS: original, non-crossover, paid LT claims with patient status discharged to home

Specification

STEP 1: Active non-duplicate LT claims during DQ report month Define the LT 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: Medicaid 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 = "1" 2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missing STEP 3: Patient status of discharged to home Of the claims that meet the criteria from STEP 2, select claims with home patient status: 1. PATIENT-STATUS = “01” or “06” or “08” or “50” or “81” or “86” STEP 4: Calculate percentage for measure Divide the count of claims from STEP 3 by the count of claims in STEP 2