MCR-60-002-2

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Measure Name	% of claim headers that have an invalid Billing Provider Taxonomy
File Type	CLT
Measure ID	MCR-60-002-2
Measure Type	Claims Percentage
Content area	MCR

Validation Type	Inferential

Measure Priority	N/A
Focus Area	N/A
Category	N/A

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

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

DD Data Element	BILLING-PROV-TAXONOMY
DD Data Element Number	CLT132

Annotation	N/A
Specification	N/A

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Published Date	Data Guide Version	DQM	Action	Field	Before	After
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	Priority	High	N/A
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	Category	Provider information	N/A
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	For ta comprehensive	TA- Inferential	No
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	For ta inferential	Yes	No
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	Ta min	0
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	Ta max	0.05
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original and adjustment, paid LT claims with a non-missing billing provider taxonomy that is equal to an invalid value	N/A
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT 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
06/19/2024	3.27.0	MCR-60-002-2	UPDATE	Focus area	Managed care	N/A

MCR-60-002-2

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements