FFS-26-014-14

Data Quality Measure

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Key Information

Measure Name	% of claim lines without a valid Line Adjustment Indicator (LINE-ADJ-IND is 2, 3, 9, other invalid value, or missing)
File Type	COT
Measure ID	FFS-26-014-14
Measure Type	Claims percentage
Content area	FFS

Validation

Validation Type	Inferential

Measure Priority

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

Claim Information

Claim Type	CHIP,FFS
Adjustment Type	All Adjustment Types
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	LINE-ADJUSTMENT-IND
DD Data Element Number	COT162

Annotation	Calculate the percentage of unique line records associated with S-CHIP FFS: original and adjustment, paid OT claims with an invalid or missing adjustment indicator value
Specification	STEP 1: Active non-duplicate OT records during DQ report month Define the OT records 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: S-CHIP FFS: 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 = "A" STEP 3: Total Count Of the claims that meet the criteria from STEP 2, count the number of unique line records. STEP 4: Count invalid adjustment indicators From the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missing STEP 5: Percentage Divide the count of unique line records from STEP 4 by the count in STEP 3

Annotation

Calculate the percentage of unique line records associated with S-CHIP FFS: original and adjustment, paid OT claims with an invalid or missing adjustment indicator value

Specification

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

Define the OT records 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: S-CHIP FFS: 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 = "A"

STEP 3: Total Count

Of the claims that meet the criteria from STEP 2, count the number of unique line records.

STEP 4: Count invalid adjustment indicators

From the records from STEP 2, count unique line records with LINE-ADJUSTMENT-IND not equal to ("0", "1", "4", "5", "6") or is missing

STEP 5: Percentage

Divide the count of unique line records from STEP 4 by the count in STEP 3