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Measure Name | % missing: REFERRING-PROV-NPI-NUM (CLT00002) |
---|---|
File Type | CLT |
Measure ID | MIS-23-037-37 |
Measure Type | Claims Percentage |
Content area | MIS |
Validation Type | Inferential |
---|
Measure Priority | Medium |
---|---|
Focus Area | N/A |
Category | Provider information |
Claim Type | Medicaid,FFS or CHIP,FFS |
---|---|
Adjustment Type | Original and Replacement |
Crossover Type | All Indicators |
Minimum | 0.9 |
---|---|
Maximum | 1 |
TA Minimun | 0.9 |
TA Maximum | 1 |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | REFERRING-PROV-NPI-NUM |
---|---|
DD Data Element Number | CLT136 |
Annotation | Character |
---|---|
Specification |
STEP 1: Active non-duplicate LT claims during DQ 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: Medicaid or S-CHIP FFS or Encounter: Original and Replacement, Paid Claims Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria: 1. TYPE-OF-CLAIM = "1" or "A" 2. ADJUSTMENT-IND = "0" or "4" STEP 3: Missing data element Of the claims that meet the criteria from STEP 2, select those where For alphanumeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9 For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9 STEP 4: Calculate percentage Divide the count of claims from STEP 3 by the count of claims from STEP 2 |