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Measure Name | Total # of claim headers |
---|---|
File Type | CLT |
Measure ID | MCR-5-001-21 |
Measure Type | Count |
Content area | MCR |
Validation Type | Longitudinal |
---|
Measure Priority | Medium |
---|---|
Focus Area | Managed care |
Category | Utilization |
Claim Type | Medicaid,Enc |
---|---|
Adjustment Type | Original |
Crossover Type | Non-Crossover |
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 |
DD Data Element | |
---|---|
DD Data Element Number |
Annotation | Total number of Medicaid Encounter: original, non-crossover, paid LT claims |
---|---|
Specification |
STEP 1: Active non-duplicate LT claims during DQ report month Define the LT 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: Count claims Count the number of unique records that satisfy the constraints of STEP 2 |