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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-7445

Data Quality Measure
Last updated

Key Information

Measure Name % of claim lines that have a SERVICING-PROV-NUM that does not have a match in PRV00007 with active provider enrollment status (PROV-MEDICAID-ENROLLMENT-STATUS-CODE in (1, 2, 3, 4, 5, 6) on Beginning Date of Service
File Type Multiple Files
Measure ID RULE-7445
Measure Type Claims Percentage
Content area ALL MULTI PRO

Validation

Validation Type Inferential

Measure Priority

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

Claim Information

Claim Type Medicaid,FFS or Medicaid,Enc or CHIP,FFS or CHIP,Enc
Adjustment Type All Adjustment Types
Crossover Type All Indicators

Thresholds

Minimum 0
Maximum 0.05
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 SERVICING-PROV-NUM • SUBMITTING-STATE-PROV-ID • PROV-MEDICAID-ENROLLMENT-STATUS-CODE • BEGINNING-DATE-OF-SERVICE • PROV-MEDICAID-EFF-DATE • PROV-MEDICAID-END-DATE
DD Data Element Number COT189 • PRV097 • PRV100 • COT166 • PRV098 • PRV099

Annotation N/A
Specification RULE-7445