An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide Medicaid.gov
Version 3.27.0

MCR-32-007-7

Data Quality Measure
Last updated

No Updates

Key Information

Measure Name % of claim lines without a valid Line Adjustment Indicator (LINE-ADJ-IND is 2, 3, 9, other invalid value, or missing)
File Type COT
Measure ID MCR-32-007-7
Measure Type Claims percentage
Content area MCR

Validation

Validation Type Inferential

Measure Priority

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

Claim Information

Claim Type Medicaid,Cap
Adjustment Type All Adjustment Types
Crossover Type All Indicators

Thresholds

Minimum 0
Maximum 0.001
TA Minimun
TA Maximum
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		No
For TA
(Longitudinal) 		No

Data Elements

DD Data Element LINE-ADJUSTMENT-IND
DD Data Element Number COT162

Annotation Calculate the percentage of unique line records associated with Medicaid Capitation Payment: original and adjustment, paid OT claims with an invalid or missing adjustment indicator value
Specification STEP 1: Active non-duplicate OT records during DQ report month

Define the OT records universe at the line 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 Capitation Payment: Original and Adjustment, Paid Claims

Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria:

1. TYPE-OF-CLAIM = "2"



STEP 3: Total Count

Of the claims that meet the criteria from STEP 2, count the number of unique line records.



STEP 4: Count invalid adjustment indicators

From the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missing



STEP 5: Percentage

Divide the count of unique line records from STEP 4 by the count in STEP 3