Key Information

Measure Name	Average # of diagnoses
File Type	CLT
Measure ID	FFS-7-004-18
Measure Type	Average # Occurrences
Content area	FFS

Validation

Validation Type	Longitudinal

Measure Priority

Measure Priority	High
Focus Area	N/A
Category	Utilization

Claim Information

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

Thresholds

Minimum	1
Maximum	5
TA Minimun	1
TA Maximum	5
Longitudinal Threshold	0.25
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	DIAGNOSIS-CODE-1 • DIAGNOSIS-CODE-5
DD Data Element Number	CLT029 • CLT041

Annotation

Average number of diagnoses codes for S-CHIP FFS: original, non-crossover, paid LT claims

Specification

STEP 1: Active non-duplicate paid LT claims during report month Define the LT 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: S-CHIP 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 = "A" 2. ADJUSTMENT-IND = "0" 3. CROSSOVER-INDICATOR = "0" or is missing STEP 3: Non-missing diagnoses codes Of the claims that meet the criteria from STEP 2, set Count_Elements equal to the total number of non-missing data elements IN DIAGNOSIS-CODE-1, DIAGNOSIS-CODE-2 ... DIAGNOSIS-CODE-5 STEP 4: Total number of diagnoses Sum Count_Elements for all claims in STEP 3 STEP 5: Calculate the average for measure Divide the sum from STEP 4 by the count of claims from STEP 2