An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide Medicaid.gov
Version 3.30.0

MCR-62-007-7

Data Quality Measure
Last updated

No Updates

Key Information

Measure Name % of claim lines where TYPE-OF-BILL does not begin with 03, 07, 08, 012, 013, 014, 022, 023, 024
File Type COT
Measure ID MCR-62-007-7
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 COT038

Annotation Calculate the percent of Medicaid and S-CHIP: Encounter, original and adjustment, paid OT claims where type of bill does not begin with a value normally found on the OT file
Specification STEP 1: Active non-duplicate paid OT claims during report month

Define the OT claims universe at the line level by importing both headers and lines that satisfy the following criteria:



For Headers:

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.



For Lines:

1. Reporting Period from the filename = DQ report month

2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing

3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.

4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-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 “03”or “07”or “08”or “012”or “013”or “014”or “022”or “023”or "024”



STEP 5: Calculate percent

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