FFS-52-007-7

Data Quality Measure

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Key Information

Measure Name	% of claim lines where TYPE-OF-BILL does not begin with 03, 07, 08, 012, 013, 014, 022, 023, 024
File Type	COT
Measure ID	FFS-52-007-7
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	0.05
TA Minimun	0
TA Maximum	0.05
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	COT038

Annotation	Calculate the percent of Medicaid and S-CHIP: FFS, original and adjustment, paid OT claims where type of bill does not begin with a value normally found on the OT file
Specification	STEP 1: Active non-duplicate paid OT claims during report month Define the OT claims universe at the line 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: 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 “03”or “07”or “08”or “012”or “013”or “014”or “022”or “023”or “024” 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 OT claims where type of bill does not begin with a value normally found on the OT file

Specification

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

Define the OT claims universe at the line 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: 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 “03”or “07”or “08”or “012”or “013”or “014”or “022”or “023”or “024”

STEP 5: Calculate percent

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