FFS-52-006-6

Data Quality Measure

Last updated

No Updates

Key Information

Measure Name	% of claim headers where TYPE-OF-BILL does not begin with 02 (nursing facility) or 06 (ICF)
File Type	CLT
Measure ID	FFS-52-006-6
Measure Type	Claims Percentage
Content area	FFS

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	High
Focus Area	N/A
Category	Utilization

Claim Information

Claim Type	Medicaid,FFS or CHIP,FFS
Adjustment Type	All Adjustment Types
Crossover Type	All Indicators

Thresholds

Minimum	0
Maximum	0.1
TA Minimun	0
TA Maximum	0.1
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	TYPE-OF-BILL
DD Data Element Number	CLT053

Annotation	Calculate the percent of Medicaid and S-CHIP: FFS, original and adjustment, paid LT claims where type of bill does not begin with the value for "nursing facility" or "ICF"
Specification	STEP 1: Active non-duplicate paid LT claims during report month Define the LT 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 FFS: 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 = "1" or "A" STEP 3: Non-missing type of bill Of the claims that meet the criteria from STEP 2, restrict to non-missing TYPE-OF-BILL STEP 4: Count of claims with an invalid type of bill Of the claims that meet the criteria from STEP 3, count claims where TYPE-OF-BILL does not begin with "02" or "06" STEP 5: Calculate percent Divide the count from STEP 4 by the count from STEP 3

Annotation

Calculate the percent of Medicaid and S-CHIP: FFS, original and adjustment, paid LT claims where type of bill does not begin with the value for "nursing facility" or "ICF"

Specification

STEP 1: Active non-duplicate paid LT claims during report month

Define the LT 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 FFS: 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 = "1" or "A"

STEP 3: Non-missing type of bill

Of the claims that meet the criteria from STEP 2, restrict to non-missing TYPE-OF-BILL

STEP 4: Count of claims with an invalid type of bill

Of the claims that meet the criteria from STEP 3, count claims where TYPE-OF-BILL does not begin with "02" or "06"

STEP 5: Calculate percent

Divide the count from STEP 4 by the count from STEP 3