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Measure Name | # of plans with at least 100 enrollments and some encounters that have OT ratios outside of the expected range (0.1 - 20) |
---|---|
File Type | Multiple Files |
Measure ID | MCR-54-007-7 |
Measure Type | Count |
Content area | MCR |
Validation Type | Inferential |
---|
Measure Priority | Medium |
---|---|
Focus Area | Managed care |
Category | Utilization |
Claim Type | N/A |
---|---|
Adjustment Type | N/A |
Crossover Type | N/A |
Minimum | 0 |
---|---|
Maximum | 0 |
TA Minimun | 0 |
TA Maximum | 0 |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | TYPE-OF-SERVICE |
---|---|
DD Data Element Number | COT186 |
Annotation | Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some encounters that have an encounter OT ratio outside of (0.1, 20), with plan types equal to 01, 04, 05, 06, 07, 08, 09, 10, 11, 12, 13, 14, 15, 16, or 80 |
---|---|
Specification |
STEP 1: Inclusions Based on Plan Type Of the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where: 1. Plan_Type_El is equal to ("01","04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14", "15", "16", or "80") STEP 2: Enrollment and encounters Of the Plan_Ids that meet the criteria in STEP 1, further refine them by keeping those that satisfy the following criteria: 1. Enrollment >= 100 2. Total_Encounters > 0 STEP 3: Encounters OT ratio out of expected range Of the Plan_Ids that meet the criteria in STEP 2, count the non-missing Plan_Ids where: 1. Encounters_Ot_Ratio < 0.1 OR Encounters_Ot_Ratio > 20 |