MCR-1-004-16

Data Quality Measure

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Key Information

Measure Name	Average # of diagnoses
File Type	CIP
Measure ID	MCR-1-004-16
Measure Type	Average # Occurrences
Content area	MCR

Validation

Validation Type	Longitudinal and Inferential

Measure Priority

Measure Priority	High
Focus Area	Managed care
Category	Utilization

Claim Information

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

Thresholds

Minimum	2
Maximum	12
TA Minimun	2
TA Maximum	12
Longitudinal Threshold	0.15
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	DIAGNOSIS-CODE-1 • DIAGNOSIS-CODE-12
DD Data Element Number	CIP032 • CIP065

Annotation	Average number of diagnoses codes for Medicaid Encounter: original, non-crossover, paid IP claims
Specification	STEP 1: Active non-duplicate paid IP claims during report month Define the IP 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 Encounter: 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 = "3" 2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missing STEP 3: Non-missing diagnoses codes Of the claims that meet the criteria from STEP 2, set Count_Elements equal to the total number of non-missing data elements IN DIAGNOSIS-CODE-1, DIAGNOSIS-CODE-2 ... DIAGNOSIS-CODE-12 STEP 4: Total number of diagnoses Sum Count_Elements for all claims in STEP 3 STEP 5: Calculate the average for measure Divide the sum from STEP 4 by the count of claims from STEP 2

Annotation

Average number of diagnoses codes for Medicaid Encounter: original, non-crossover, paid IP claims

Specification

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

Define the IP 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 Encounter: 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 = "3"

2. ADJUSTMENT-IND = "0"

3. CROSSOVER-INDICATOR = "0" or is missing

STEP 3: Non-missing diagnoses codes

Of the claims that meet the criteria from STEP 2, set Count_Elements equal to the total number of non-missing data elements IN DIAGNOSIS-CODE-1, DIAGNOSIS-CODE-2 ... DIAGNOSIS-CODE-12

STEP 4: Total number of diagnoses

Sum Count_Elements for all claims in STEP 3

STEP 5: Calculate the average for measure

Divide the sum from STEP 4 by the count of claims from STEP 2