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" 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

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"

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