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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

FFS-5-004-28

Data Quality Measure
Last updated

Key Information

Measure Name Average # of diagnoses
File Type CLT
Measure ID FFS-5-004-28
Measure Type Average # Occurrences
Content area FFS

Validation

Validation Type Longitudinal

Measure Priority

Measure Priority High
Focus Area N/A
Category Utilization

Claim Information

Claim Type Medicaid,FFS
Adjustment Type Original
Crossover Type Non-Crossover

Thresholds

Minimum 1
Maximum 37
TA Minimun 1
TA Maximum 37
Longitudinal Threshold 0.25
For TA
(for including in compliance training) 		TA- Inferential
For TA
(Longitudinal) 		No

Data Elements

DD Data Element DIAGNOSIS-CODE
DD Data Element Number CLT278

Annotation Average number of diagnosis codes for Medicaid FFS: original, non-crossover, paid LT claims
Specification STEP 1: Active non-duplicate paid LT claims during report month

Define the LT 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 FFS: Original, Non-Crossover, Paid Claims

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

1. TYPE-OF-CLAIM = "1"

2. ADJUSTMENT-IND = "0"

3. CROSSOVER-INDICATOR = "0" or is missing



STEP 3: DX Segments

1. DX segments merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND.

2. No DX Duplicates: Duplicates are dropped at the diagnosis level, if the following seven data elements are the same: SUBMITTING-STATE, ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, ADJUSTMENT-IND, DIAGNOSIS-TYPE-CODE, and DIAGNOSIS-SEQUENCE-NUMBER.



STEP 4: Non-missing diagnosis codes

Of the DX segments that meet the criteria from STEP 3, set Count_Elements equal to the total number of DX segments in STEP 3 where

1. DIAGNOSIS-CODE is not missing

2a. DIAGNOSIS-TYPE is not missing

AND

2b. DIAGNOSIS-TYPE is not equal to ("A")



STEP 5: Total number of diagnoses

Sum Count_Elements for all claims in STEP 4



STEP 6: Calculate the average for measure

Divide the sum from STEP 5 by the count of claims from STEP 2