TPL-2-006-6

Data Quality Measure

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Key Information

Measure Name	% of claim lines with any valid Other TPL Collection code
File Type	COT
Measure ID	TPL-2-006-6
Measure Type	Claims Percentage
Content area	TPL TPL

Validation

Validation Type	Longitudinal and Inferential

Measure Priority

Measure Priority	N/A
Focus Area	N/A
Category	N/A

Claim Information

Claim Type	Medicaid,FFS
Adjustment Type	Original
Crossover Type	Non-Crossover

Thresholds

Minimum	0.0001
Maximum	0.1
TA Minimun
TA Maximum
Longitudinal Threshold	0.15
For TA (for including in compliance training)	No
For TA (Longitudinal)	No

Data Elements

DD Data Element	OTHER-TPL-COLLECTION
DD Data Element Number	COT058

Annotation	Percentage of Medicaid FFS: original, non-crossover, paid OT claim lines with any valid value for other TPL collection code
Specification	STEP 1: Active non-duplicate OT claims during DQ report month Define the OT claims universe at the line 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 FFS: Original, Non-Crossover, Paid Claims Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria: 1. TYPE-OF-CLAIM = "1" 2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missing STEP 3: Other TPL collection code Of the claims that meet the criteria from STEP 2, select claims with a valid value for other TPL collection code: 1. OTHER-TPL-COLLECTION = (“001” or “002” or “003” or “004” or “005” or “006” or “007”) STEP 4: Calculate the percentage for the measure Divide the count of claim lines from STEP 3 by the count of claim lines from STEP 2

Annotation

Percentage of Medicaid FFS: original, non-crossover, paid OT claim lines with any valid value for other TPL collection code

Specification

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

Define the OT claims universe at the line 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 FFS: Original, Non-Crossover, Paid Claims

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

1. TYPE-OF-CLAIM = "1"

2. ADJUSTMENT-IND = "0"

3. CROSSOVER-INDICATOR = "0" or is missing

STEP 3: Other TPL collection code

Of the claims that meet the criteria from STEP 2, select claims with a valid value for other TPL collection code:

1. OTHER-TPL-COLLECTION = (“001” or “002” or “003” or “004” or “005” or “006” or “007”)

STEP 4: Calculate the percentage for the measure

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