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Measure Name | Average # accommodation codes on claims with accommodation codes |
---|---|
File Type | CIP |
Measure ID | MCR-1-016-20 |
Measure Type | Average # Occurrences |
Content area | MCR |
Validation Type | Longitudinal and Inferential |
---|
Measure Priority | Medium |
---|---|
Focus Area | Managed care |
Category | Utilization |
Claim Type | Medicaid,Enc |
---|---|
Adjustment Type | Original |
Crossover Type | Non-Crossover |
Minimum | 1 |
---|---|
Maximum | 3 |
TA Minimun | 1 |
TA Maximum | 3 |
Longitudinal Threshold | 0.15 |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | REVENUE-CODE |
---|---|
DD Data Element Number | CIP245 |
Annotation | Average number of accommodation revenue 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 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 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: Accommodation revenue codes Of the claims that meet the criteria from STEP 2, select records where: 1. REVENUE-CODE = "0100" through "0219" STEP 4: Unique header records Count the number of unique header records that meet the criteria from STEP 3 STEP 5: Unique line records Count the number of unique line records that meet the criteria from STEP 3 STEP 6: Calculate the average for measure Divide the count from STEP 5 by the count from STEP 4 |