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Measure Name | % of claim headers with a BILLING-PROV-NUM that does not have a match in PRV00007 with active provider enrollment status (PROV-MEDICAID-ENROLLMENT-STATUS-CODE in (1, 2, 3, 4, 5, 6) on Admission Date |
---|---|
File Type | Multiple Files |
Measure ID | RULE-7439 |
Measure Type | Claims Percentage |
Content area | ALL MULTI PRO |
Validation Type | Inferential |
---|
Measure Priority | High |
---|---|
Focus Area | N/A |
Category | Provider enrollment |
Claim Type | Medicaid,FFS or Medicaid,Enc or CHIP,FFS or CHIP,Enc |
---|---|
Adjustment Type | All Adjustment Types |
Crossover Type | All Indicators |
Minimum | 0 |
---|---|
Maximum | 0.05 |
TA Minimun | 0 |
TA Maximum | 0.05 |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | BILLING-PROV-NUM • SUBMITTING-STATE-PROV-ID • PROV-MEDICAID-ENROLLMENT-STATUS-CODE • ADMISSION-DATE • PROV-MEDICAID-EFF-DATE • PROV-MEDICAID-END-DATE |
---|---|
DD Data Element Number | CIP179 • PRV097 • PRV100 • CIP094 • PRV098 • PRV099 |
Annotation | N/A |
---|---|
Specification | RULE-7439 |