MCR-62-005-5

Data Quality Measure

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Key Information

Measure Name	% of claim headers where TYPE-OF-BILL does not begin with 011 (inpatient hospital)
File Type	CIP
Measure ID	MCR-62-005-5
Measure Type	Claims Percentage
Content area	MCR

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	High
Focus Area	Managed care
Category	Utilization

Claim Information

Claim Type	Medicaid,Enc or CHIP,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	TYPE-OF-BILL
DD Data Element Number	CIP101

Annotation	Calculate the percent of Medicaid and S-CHIP: Encounter, original and adjustment, paid IP claims where type of bill does not begin with the value for "inpatient hospital"
Specification	STEP 1: Active non-duplicate paid IP claims during report month Define the IP 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 type of bill Of the claims that meet the criteria from STEP 2, restrict to non-missing TYPE-OF-BILL STEP 4: Count of claims with an invalid type of bill Of the claims that meet the criteria from STEP 3, count claims where TYPE-OF-BILL does not begin with "011" STEP 5: Calculate percent Divide the count from STEP 4 by the count from STEP 3

Annotation

Calculate the percent of Medicaid and S-CHIP: Encounter, original and adjustment, paid IP claims where type of bill does not begin with the value for "inpatient hospital"

Specification

STEP 1: Active non-duplicate paid IP claims during report month

Define the IP 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 type of bill

Of the claims that meet the criteria from STEP 2, restrict to non-missing TYPE-OF-BILL

STEP 4: Count of claims with an invalid type of bill

Of the claims that meet the criteria from STEP 3, count claims where TYPE-OF-BILL does not begin with "011"

STEP 5: Calculate percent

Divide the count from STEP 4 by the count from STEP 3