MCR-56-001-1

Data Quality Measure

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Key Information

Measure Name	% of claims for which Patient Status is NOT "still a patient" but are missing Discharge Date
File Type	CIP
Measure ID	MCR-56-001-1
Measure Type	Claims Percentage
Content area	MCR

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	Critical
Focus Area	Managed care
Category	File integrity

Claim Information

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

Thresholds

Minimum	0
Maximum	0.05
TA Minimun	0
TA Maximum	0.05
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	PATIENT-STATUS • DISCHARGE-DATE
DD Data Element Number	CIP199 • CIP096

Annotation	The percentage of claims that are Medicaid Encounter: original and adjustment, and paid where patient status is not "Still a patient" and the discharge date is missing
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: Medicaid 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 = "3" STEP 3: Patient status is not "Still a Patient" Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PATIENT-STATUS is not equal to "30" 2. PATIENT-STATUS is not missing STEP 4: Missing discharge date Of the claims from STEP 3, select records where: 1. DISCHARGE-DATE is missing STEP 5: Calculate percentage Divide the number of claims from STEP 4 by the number of claims from STEP 3

Annotation

The percentage of claims that are Medicaid Encounter: original and adjustment, and paid where patient status is not "Still a patient" and the discharge date is missing

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: Medicaid 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 = "3"

STEP 3: Patient status is not "Still a Patient"

Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:

1. PATIENT-STATUS is not equal to "30"

2. PATIENT-STATUS is not missing

STEP 4: Missing discharge date

Of the claims from STEP 3, select records where:

1. DISCHARGE-DATE is missing

STEP 5: Calculate percentage

Divide the number of claims from STEP 4 by the number of claims from STEP 3