FFS-54-001

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Measure Name	% of crossover claim headers where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, and TOT-MEDICARE-DEDUCTIBLE-AMT are 0 or missing
File Type	CIP
Measure ID	FFS-54-001_1-5
Measure Type	Claims Percentage
Content area	FFS

Validation Type	Inferential

Measure Priority	N/A
Focus Area	N/A
Category	N/A

Claim Type	Medicaid,FFS or CHIP,FFS
Adjustment Type	Non-void
Crossover Type	Crossover

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	MEDICARE-PAID-AMT • TOT-MEDICARE-COINS-AMT • TOT-MEDICARE-DEDUCTIBLE-AMT
DD Data Element Number	CIP228 • CIP117 • CIP116

Annotation	N/A
Specification	N/A

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Published Date	Data Guide Version	DQM	Action	Field	Before	After
04/21/2023	3.6.0	FFS-54-001_1-5	UPDATE	Priority	High	N/A
04/21/2023	3.6.0	FFS-54-001_1-5	UPDATE	Category	Expenditures	N/A
04/21/2023	3.6.0	FFS-54-001_1-5	UPDATE	For ta comprehensive	TA- Inferential	No
04/21/2023	3.6.0	FFS-54-001_1-5	UPDATE	For ta inferential	Yes	No
04/21/2023	3.6.0	FFS-54-001_1-5	UPDATE	Ta min	0
04/21/2023	3.6.0	FFS-54-001_1-5	UPDATE	Ta max	0.1
04/21/2023	3.6.0	FFS-54-001_1-5	UPDATE	Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: non-void, crossover, paid IP claims where Medicare paid amount, total Medicare coinsurance amount, and total Medicare deductible amount are equal to 0 or are missing	N/A
04/21/2023	3.6.0	FFS-54-001_1-5	UPDATE	Specification	STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. 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: Non-void, Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A" 2. CROSSOVER-IND = "1"3. ADJUSTMENT-IND not equal to "1" STEP 3: No Medicare AmountsOf the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. MEDICARE-PAID-AMT = 0 or is missing2. TOT-MEDICARE-COINS-AMT = 0 or is missing3. TOT-MEDICARE-DEDUCTIBLE-AMT = 0 or is missingSTEP 4: Calculate percentageDivide the count of claim headers from STEP 3 by the count of claim headers from STEP 2	N/A

FFS-54-001_1-5

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements