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TMSIS Dataguide Medicaid.gov
Version 3.27.0

MIS-26-001-1

Data Quality Measure
Last updated

Key Information

Measure Name % missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (COT00003)
File Type COT
Measure ID MIS-26-001-1
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 CHIP,FFS
Adjustment Type Original and Replacement
Crossover Type All Indicators

Thresholds

Minimum 0
Maximum 0.1
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 CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT
DD Data Element Number COT210

Annotation Character
Specification STEP 1: Active non-duplicate OT claims during DQ report month

Define the OT claims universe at the header 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 FFS: Original and Replacement, Paid Claims

Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria:

1. TYPE-OF-CLAIM = "1" or "A"

2. ADJUSTMENT-IND = "0" or "4"



STEP 3: 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 4: Calculate percentage

Divide the count of claim lines from STEP 3 by the count of claim lines from STEP 2