Key Information

Measure Name	Total # of claim headers
File Type	CIP
Measure ID	MCR-3-001-18
Measure Type	Count
Content area	MCR

Validation

Validation Type	Longitudinal

Measure Priority

Measure Priority	Medium
Focus Area	Managed care
Category	Utilization

Claim Information

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

Thresholds

Minimum	N/A
Maximum	N/A
TA Minimun
TA Maximum
Longitudinal Threshold	0.5
For TA (for including in compliance training)	TA- Longitudinal
For TA (Longitudinal)	Yes

Data Elements

DD Data Element
DD Data Element Number

Annotation

Total number of S-CHIP Encounter: original, non-crossover, paid IP claims

Specification

STEP 1: Active non-duplicate IP records during DQ 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: S-CHIP 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 = "C" 2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missing STEP 3: Count claims Count the number of unique records that satisfy the constraints of STEP 2