MCR-32-011-11

Data Quality Measure

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Key Information

Measure Name	% of claim headers without a valid Adjustment Indicator (ADJ-IND is 2, 3, 9, other invalid value, or missing)
File Type	CIP
Measure ID	MCR-32-011-11
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	CHIP,Enc
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	ADJUSTMENT-IND
DD Data Element Number	CIP026

Annotation	Calculate the percentage of unique header records associated with S-CHIP Encounter: original and adjustment, paid IP claims with an invalid or missing adjustment indicator value
Specification	STEP 1: Active non-duplicate IP records during DQ report month Define the IP records 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: S-CHIP Encounter: 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 = "C" STEP 3: Total Count Of the claims that meet the criteria from STEP 2, count the number of unique header records. STEP 4: Count invalid adjustment indicators From the records from STEP 2, count unique header records with ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missing STEP 5: Percentage Divide the count of unique header records from STEP 4 by the count in STEP 3

Annotation

Calculate the percentage of unique header records associated with S-CHIP Encounter: original and adjustment, paid IP claims with an invalid or missing adjustment indicator value

Specification

STEP 1: Active non-duplicate IP records during DQ report month

Define the IP records 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: S-CHIP Encounter: 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 = "C"

STEP 3: Total Count

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

STEP 4: Count invalid adjustment indicators

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

STEP 5: Percentage

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