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Measure Name | % of claim headers where BILLING-PROV-TAXONOMY does not begin with 283Q, 283X, 282E, 31, 32, 385H, or 281P |
---|---|
File Type | CLT |
Measure ID | MCR-62-002-2 |
Measure Type | Claims Percentage |
Content area | MCR |
Validation Type | Inferential |
---|
Measure Priority | High |
---|---|
Focus Area | Managed care |
Category | Provider information |
Claim Type | Medicaid,Enc or CHIP,Enc |
---|---|
Adjustment Type | All Adjustment Types |
Crossover Type | All Indicators |
Minimum | 0 |
---|---|
Maximum | 0.02 |
TA Minimun | 0 |
TA Maximum | 0.02 |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | BILLING-PROV-TAXONOMY |
---|---|
DD Data Element Number | CLT132 |
Annotation | Calculate the percentage Medicaid and S-CHIP Encounter: original and adjustment, paid LT claims with billing provider taxonomy codes that do not begin with the characters "283Q" or "283X" or "282E" or "31" or "32" or "385H" or "281P" |
---|---|
Specification |
STEP 1: Active non-duplicate paid LT claims during report month Define the LT claims universe at the header level that satisfy the following criteria: 1. Reporting Period from 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 and S-CHIP 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" or "C" STEP 3: Non-missing billing provider taxonomy Of the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMY STEP 4: Billing provider taxonomy does not begin with ("283Q" or "283X" or "282E" or "31" or "32" or "385H" or "281P") Of the claims that meet the criteria from STEP 3, keep claims where BILLING-PROV-TAXONOMY does not begin with ("283Q" or "283X" or "282E" or "31" or "32" or "385H" or "281P") STEP 5: Calculate percent Divide the count of claims from STEP 4 from STEP 3 |