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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

EXP-22-009-9

Data Quality Measure
Last updated

Key Information

Measure Name % of records with Payment or Recoupment Amount = $0 or missing
File Type FTX
Measure ID EXP-22-009-9
Measure Type Non-Claims Percentage
Content area EXP

Validation

Validation Type Longitudinal and Inferential

Measure Priority

Measure Priority High
Focus Area N/A
Category Expenditures

Claim Information

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

Thresholds

Minimum 0
Maximum 0.05
TA Minimun 0
TA Maximum 0.1
Longitudinal Threshold 0.15
For TA
(for including in compliance training) 		TA- Inferential
For TA
(Longitudinal) 		No

Data Elements

DD Data Element PAYMENT-OR-RECOUPMENT-AMOUNT • PAYMENT-OR-RECOUPMENT-AMOUNT • PAYMENT-AMOUNT
DD Data Element Number FTX025 • FTX157 • FTX072

Annotation Calculate the percentage of Medicaid Capitation Payment Financial Transaction records where Payment or Recoupment Amount is equal to $0 or missing
Specification STEP 1: Active non-duplicate paid capitation payment financial transactions during report month

Define the FTX universe for the FTX0002, FTX0003, and FTX0005 tables respectively by keeping active records that satisfy the following criteria:

1. Reporting Period from the filename = DQ report month

2. No Duplicates: Duplicates are dropped at the table level, if the following four data elements are the same: ICN-ORIG, ICN-ADJ, PAYMENT-OR-RECOUPMENT-DATE, and ADJUSTMENT-IND.



STEP 2: Medicaid Capitation Payment: Original, Paid Claims

Of the records that meet the criteria from STEP 1, further restrict them by the following criteria:

1. MBESCBES-FORM-GROUP = "1" or "2"

2. ADJUSTMENT-IND = "0"



STEP 3: Payment or Recoupment Amount $0 or missing

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

1a. PAYMENT-OR-RECOUPMENT-AMOUNT = "0" or is missing

OR

1b. PAYMENT-AMOUNT= "0" or is missing



STEP 4: Calculate the percentage for the measure

Divide the count of records from STEP 3 by the count of records from STEP 2