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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 | CIP |
Measure ID | MCR-32-012-12 |
Measure Type | Claims percentage |
Content area | MCR |
Validation Type | Inferential |
---|
Measure Priority | N/A |
---|---|
Focus Area | N/A |
Category | N/A |
Claim Type | CHIP,Enc |
---|---|
Adjustment Type | All Adjustment Types |
Crossover Type | All Indicators |
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 |
DD Data Element | LINE-ADJUSTMENT-IND |
---|---|
DD Data Element Number | CIP239 |
Annotation | Calculate the percentage of unique line records associated with S-CHIP Encounter: original and adjustment, paid IP claims with an invalid or missing adjustment indicator value |
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Specification |
STEP 1: Active non-duplicate IP records during DQ report month Define the IP 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: 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 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 |