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Measure Name | % missing: MEDICAID-COV-INPATIENT-DAYS (CIP00002) |
---|---|
File Type | CIP |
Measure ID | MIS-79-034-34 |
Measure Type | Claims Percentage |
Content area | MIS |
Validation Type | Inferential |
---|
Measure Priority | Medium |
---|---|
Focus Area | Managed care |
Category | Utilization |
Claim Type | Medicaid,Enc or CHIP,Enc |
---|---|
Adjustment Type | Original and Replacement |
Crossover Type | All Indicators |
Minimum | 0 |
---|---|
Maximum | 0.02 |
TA Minimun | 0 |
TA Maximum | 0.02 |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | MEDICAID-COV-INPATIENT-DAYS |
---|---|
DD Data Element Number | CIP136 |
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) |