Key Information

Measure Name	% of service tracking claim headers with a non-zero Total Medicaid Paid Amount
File Type	COT
Measure ID	EXP-44-003-3
Measure Type	Claims Percentage
Content area	EXP

Validation

Validation Type	Inferential

Measure Priority

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

Claim Information

Claim Type	Medicaid,Serv or CHIP,Serv
Adjustment Type	Non-void
Crossover Type	All Indicators

Thresholds

Minimum	0
Maximum	0.001
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	TOT-MEDICAID-PAID-AMT
DD Data Element Number	COT050

Annotation

Calculate the percentage of Medicaid and S-CHIP service tracking, original and adjustment, paid OT claims that have a non zero Total Medicaid Paid Amount

Specification

STEP 1: Active non-duplicate paid OT claims during report month Define the OT 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 and S-CHIP Service Tracking: Original and Adjustment, Paid Claims Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria: 1. TYPE-OF-CLAIM = "4" or "D" STEP 3: Non Zero Total Medicaid Paid Amount Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. TOT-MEDICAID-PAID-AMT is non-zero 2. TOT-MEDICAID-PAID-AMT is not missing STEP 4: Calculate percentage Divide the count of claims from STEP 3 by the count from STEP 2