MCR-17-003-6

Data Quality Measure

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Key Information

Measure Name	% of claim headers with Prescription Fill Date = Date Prescribed
File Type	CRX
Measure ID	MCR-17-003-6
Measure Type	Claims Percentage
Content area	MCR

Validation

Validation Type	Longitudinal and Inferential

Measure Priority

Measure Priority	Medium
Focus Area	Managed care
Category	Utilization

Claim Information

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

Thresholds

Minimum	0.25
Maximum	0.95
TA Minimun	0.25
TA Maximum	0.95
Longitudinal Threshold	0.1
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	PRESCRIPTION-FILL-DATE • DATE-PRESCRIBED
DD Data Element Number	CRX085 • CRX084

Annotation	The percentage of Medicaid Encounter: original, non-crossover, paid RX claims where the fill date is equal to the prescribed date
Specification	STEP 1: Active non-duplicate RX claims during DQ report month Define the RX claims universe at the header level that satisfy the following criteria: 1. Reporting Period for 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: Fill date equals prescribed date Of the claims that meet the criteria from STEP 2, select records where 1. PRESCRIPTION-FILL-DATE = DATE-PRESCRIBED STEP 4: Calculate the percentage for the measure Divide the count of claims from STEP 3 by the count of claims from STEP 2

Annotation

The percentage of Medicaid Encounter: original, non-crossover, paid RX claims where the fill date is equal to the prescribed date

Specification

STEP 1: Active non-duplicate RX claims during DQ report month

Define the RX claims universe at the header level that satisfy the following criteria:

1. Reporting Period for 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: Fill date equals prescribed date

Of the claims that meet the criteria from STEP 2, select records where

1. PRESCRIPTION-FILL-DATE = DATE-PRESCRIBED

STEP 4: Calculate the percentage for the measure

Divide the count of claims from STEP 3 by the count of claims from STEP 2