MIS-79-033-33

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

MIS-79-033-33

Data Quality Measure

Last updated

Key Information

Measure Name	% missing: MEDICAID-PAID-DATE (CIP00002)
File Type	CIP
Measure ID	MIS-79-033-33
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,Enc or CHIP,Enc
Adjustment Type	Original and Replacement
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	MEDICAID-PAID-DATE
DD Data Element Number	CIP099

Annotation

Numeric

Specification

STEP 1: Active non-duplicate IP claims during DQ 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 or S-CHIP Encounter: 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 = "3" or "C"

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

STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY)

Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:

1. SOURCE-LOCATION is NOT equal to "22" or "23"

STEP 4: Missing data element

Of the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), 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 5: Calculate percentage

Divide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)

Published Date	Data Guide Version	DQM	Action	Field	Before	After
02/02/2024	3.18.0	MIS-79-033-33	UPDATE	Priority	High	N/A
02/02/2024	3.18.0	MIS-79-033-33	UPDATE	Category	Expenditures	N/A
02/02/2024	3.18.0	MIS-79-033-33	UPDATE	For ta comprehensive	TA- Inferential	No
02/02/2024	3.18.0	MIS-79-033-33	UPDATE	For ta inferential	Yes	No
02/02/2024	3.18.0	MIS-79-033-33	UPDATE	Ta min	0
02/02/2024	3.18.0	MIS-79-033-33	UPDATE	Ta max	0.02
02/02/2024	3.18.0	MIS-79-033-33	UPDATE	Focus area	Managed care	N/A
04/21/2023	3.6.0	MIS-79-033-33	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. 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 or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period from the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing6. 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 or S-CHIP Encounter: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Exclude sub-capitation encounters (For measures MIS-79-033-33, MIS-79-053-53, and MIS-79-054-54 ONLY) Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 4: Missing data elementOf the claims that meet the criteria from STEP 2 (or STEP 3 for selected measures), select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 5: Calculate percentageDivide the count of claims from STEP 4 by the count of claims from STEP 2 (or STEP 3 for selected measures)