MIS-25-013-13

Data Quality Measure

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Key Information

Measure Name	% missing: DIAGNOSIS-CODE-FLAG-1 (COT00002)
File Type	COT
Measure ID	MIS-25-013-13
Measure Type	Claims Percentage
Content area	MIS

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	Medium
Focus Area	N/A
Category	Utilization

Claim Information

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

Thresholds

Minimum	0
Maximum	0.25
TA Minimun	0
TA Maximum	0.25
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	DIAGNOSIS-CODE-FLAG-1
DD Data Element Number	COT028

Annotation	Character
Specification	STEP 1: Active non-duplicate OT claims during DQ report month Define the OT 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: 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

Annotation

Character

Specification

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

Define the OT 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: 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