MIS-85-007-7

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TMSIS Dataguide

Medicaid.gov

Version 3.38.0

MIS-85-007-7

Data Quality Measure

Last updated

Key Information

Measure Name	% missing: COMPOUND-DRUG-IND (CRX00002)
File Type	CRX
Measure ID	MIS-85-007-7
Measure Type	Claims Percentage
Content area	MIS

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	Medium
Focus Area	Managed care
Category	Utilization

Claim Information

Claim Type	Medicaid,Enc or CHIP,Enc
Adjustment Type	Original and Replacement
Crossover Type	All Indicators

Thresholds

Minimum	0.001
Maximum	0.999
TA Minimun	0.001
TA Maximum	0.999
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	COMPOUND-DRUG-IND
DD Data Element Number	CRX086

Annotation

Character

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: 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-85-014-14, MIS-85-025-25, and MIS-85-026-26 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)

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Published Date	Data Guide Version	DQM	Action	Field	Before	After
04/21/2023	3.6.0	MIS-85-007-7	UPDATE	Specification	STEP 1: Active non-duplicate RX claims during DQ report monthDefine the RX 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 RX claims during DQ report monthDefine the RX 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-85-014-14, MIS-85-025-25, and MIS-85-026-26 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)