06/19/2024 |
3.27.0 |
MCR-60-001-1 |
UPDATE |
Specification |
STEP 1: Active non-duplicate paid IP claims during report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. 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 ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"STEP 3: Non-missing billing provider taxonomyOf the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMYSTEP 4: Count of claims with an invalid billing provider taxonomyOf the claims that meet the criteria from STEP 3, count claims where BILLING-PROV-TAXONOMY is not equal to a valid valueSTEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3 |
N/A |