EXP-43-008-8

Data Quality Measure

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Key Information

Measure Name	# of non-service tracking claim headers with non-missing Service Tracking Payment Amount
File Type	CRX
Measure ID	EXP-43-008-8
Measure Type	Count
Content area	EXP

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	High
Focus Area	N/A
Category	Expenditures

Claim Information

Claim Type	N/A
Adjustment Type	All Adjustment Types
Crossover Type	All Indicators

Thresholds

Minimum	0
Maximum	25
TA Minimun	0
TA Maximum	25
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	TYPE-OF-CLAIM • SERVICE-TRACKING-PAYMENT-AMT
DD Data Element Number	CRX029 • CRX051

Annotation	Calculate the number of non-service tracking, paid RX claims with a non-missing service tracking payment amount
Specification	STEP 1: Active non-duplicate RX records during DQ report month Define the RX records universe at the header level that satisfy the following criteria: 1. Reporting Period for 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: Non-service tracking claims Of the claims that meet the criteria from STEP 1, count the number of claims that satisfy the following criteria: 1. TYPE-OF-CLAIM does not equal ("4", "D", or "X") STEP 3: Count claims with a non-missing service tracking payment amount Of the claims that meet the criteria from STEP 2, count the number of claims that satisfy the following criteria: 1. SERVICE-TRACKING-PAYMENT-AMT is not missing 2. SERVICE-TRACKING-PAYMENT-AMT does not equal "0"

Annotation

Calculate the number of non-service tracking, paid RX claims with a non-missing service tracking payment amount

Specification

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

Define the RX records universe at the header level that satisfy the following criteria:

1. Reporting Period for 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: Non-service tracking claims

Of the claims that meet the criteria from STEP 1, count the number of claims that satisfy the following criteria:

1. TYPE-OF-CLAIM does not equal ("4", "D", or "X")

STEP 3: Count claims with a non-missing service tracking payment amount

Of the claims that meet the criteria from STEP 2, count the number of claims that satisfy the following criteria:

1. SERVICE-TRACKING-PAYMENT-AMT is not missing

2. SERVICE-TRACKING-PAYMENT-AMT does not equal "0"