ALL-20-003-3

Data Quality Measure

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Key Information

Measure Name	% of claim lines with both XIX and XXI MBESCBES Category of Service
File Type	COT
Measure ID	ALL-20-003-3
Measure Type	Claims Percentage
Content area	ALL

Validation

Validation Type	Inferential

Measure Priority

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

Claim Information

Claim Type	Medicaid,FFS or CHIP,FFS
Adjustment Type	Original and Replacement
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	XIX-MBESCBES-CATEGORY-OF-SERVICE • XXI-MBESCBES-CATEGORY-OF-SERVICE
DD Data Element Number	COT211 • COT212

Annotation	Calculate the percentage of Medicaid and S-CHIP FFS: original and replacement paid OT claim lines indicating federal funding under both Title XIX (Medicaid) and Title XXI (S-CHIP)
Specification	STEP 1: Active non-duplicate OT records during DQ report month Define the OT records universe at the line level by importing 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 and S-CHIP FFS: Original and Replacement Paid Claims Of the claim lines 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: STEP 3: Title XIX and Title XXI funding Of the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria: 1. XIX-MBESCBES-CATEGORY-OF-SERVICE is not missing 2. XXI-MBESCBES-CATEGORY-OF-SERVICE is not missing STEP 4: Calculate percentage Divide the count of claim lines from STEP 3 by the count of claim lines from STEP 2

Annotation

Calculate the percentage of Medicaid and S-CHIP FFS: original and replacement paid OT claim lines indicating federal funding under both Title XIX (Medicaid) and Title XXI (S-CHIP)

Specification

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

Define the OT records universe at the line level by importing 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 and S-CHIP FFS: Original and Replacement Paid Claims

Of the claim lines 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: STEP 3: Title XIX and Title XXI funding

Of the claim lines that meet the criteria from STEP 2, further restrict them by the following criteria:

1. XIX-MBESCBES-CATEGORY-OF-SERVICE is not missing

2. XXI-MBESCBES-CATEGORY-OF-SERVICE is not missing

STEP 4: Calculate percentage

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