MCR-1-010-5

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Measure Name	% of claim headers with Patient Status of other institution
File Type	CIP
Measure ID	MCR-1-010-5
Measure Type	Claims Percentage
Content area	MCR

Validation Type	Longitudinal and Inferential

Measure Priority	Medium
Focus Area	Managed care
Category	Utilization

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

Minimum	0.02
Maximum	0.12
TA Minimun	0.0001
TA Maximum	0.2
Longitudinal Threshold	0.05
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

DD Data Element	PATIENT-STATUS
DD Data Element Number	CIP199

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	MCR-1-010-5	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, non-crossover, paid IP claims with patient status of discharged to other institution	N/A
11/20/2025	4.0.22	MCR-1-010-5	UPDATE	Specification	STEP 1: Active non-duplicate IP claims during DQ report monthDefine the IP claims universe at the header level that satisfy the following criteria:1. Reporting Period for the filename = DQ report month2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing4. TYPE-OF-CLAIM is not equal to "Z" or is missing5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing6. 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 Encounter: Original, Non-Crossover, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3"2. ADJUSTMENT-IND = "0"3. CROSSOVER-INDICATOR = "0" or is missingSTEP 3: Patient status of discharged to other institutionOf the claims that meet the criteria from STEP 2, select claims with patient status of other institution:1. PATIENT-STATUS = “02” or “03” or “04” or “05” or “43” or “51” or “61” or “62” or “63” or “64” or “65” or “66” or “70” or “82” or “83” or “84” or “85” or “88” or “89” or “90” or “91” or “92” or “93” or “94” or “95”STEP 4 : Calculate percentage for measureDivide the count of claims from STEP 3 by the count of claims from STEP 2.	N/A
04/24/2025	4.0.7	MCR-1-010-5	ADD	N/A		Created

MCR-1-010-5

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements