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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

ALL-34-001-1

Data Quality Measure
Last updated

No Updates

Key Information

Measure Name % of claim lines with non-missing HCBS Service Code that have missing HCBS Taxonomy
File Type COT
Measure ID ALL-34-001-1
Measure Type Claims Percentage
Content area ALL

Validation

Validation Type Inferential

Measure Priority

Measure Priority Medium
Focus Area N/A
Category Utilization

Claim Information

Claim Type Medicaid,FFS or Medicaid,Enc
Adjustment Type Original and Replacement
Crossover Type All Indicators

Thresholds

Minimum 0
Maximum 0.01
TA Minimun 0
TA Maximum 0.01
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		TA- Inferential
For TA
(Longitudinal) 		No

Data Elements

DD Data Element HCBS-SERVICE-CODE • HCBS-TAXONOMY
DD Data Element Number COT187 • COT188

Annotation Calculate the percentage of Medicaid FFS and Encounter: original and replacement, paid OT claim lines with non-missing HCBS Service Code that have missing HCBS Taxonomy
Specification STEP 1: Active non-duplicate paid OT claims during report month

Define the OT claims 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: Medicaid FFS and 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 "3"

2. ADJUSTMENT-IND = "0" or "4"



STEP 3: Non-missing HCBS service code

Of the claims that meet criteria from STEP 2, keep those with non-missing HCBS-SERVICE-CODE



STEP 4: Missing HCBS taxonomy

Of the claims that meet criteria from STEP 3, keep those with missing HCBS-TAXONOMY



STEP 5: Calculate percentage

Divide the count of claim lines from STEP 4 by the count of claim lines from STEP 3