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TMSIS Dataguide Medicaid.gov
Version 3.38.0

MIS-19-001-1

Data Quality Measure
Last updated

Key Information

Measure Name % missing: TYPE-OF-CLAIM (CRX00002)
File Type CRX
Measure ID MIS-19-001-1
Measure Type Claims Percentage
Content area MIS

Validation

Validation Type Inferential

Measure Priority

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

Claim Information

Claim Type Medicaid,FFS or Medicaid,Cap or Medicaid,Enc or Medicaid,Serv or Medicaid,Supp or CHIP,FFS or CHIP,Cap or CHIP,Enc or CHIP,Serv or CHIP,Supp
Adjustment Type All Adjustment Types
Crossover Type All Indicators

Thresholds

Minimum 0
Maximum 0.02
TA Minimun
TA Maximum
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		No
For TA
(Longitudinal) 		No

Data Elements

DD Data Element TYPE-OF-CLAIM
DD Data Element Number CRX029

Annotation Alphanumeric
Specification STEP 1: Active non-duplicate RX claims during DQ report month

Define the RX 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: Missing data element

Of the claims that meet the criteria from STEP 2, select those where



For alphanumeric data elements:

1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9



For numeric data elements:

1. [DATA-ELEMENT-NAME] does not contain any digit 1-9



STEP 3: Calculate percentage

Divide the count of claims from STEP 2 by the count of claims from STEP 1