MCR-5-005-16

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Measure Name	% of claim headers with Patient Status of still a patient
File Type	CLT
Measure ID	MCR-5-005-16
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	0.5
Maximum	0.99
TA Minimun	0.4
TA Maximum	0.9999
Longitudinal Threshold	0.1
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

DD Data Element	PATIENT-STATUS
DD Data Element Number	CLT141

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	MCR-5-005-16	UPDATE	Annotation	Calculate the percentage of Medicaid Encounter: original, non-crossover, paid LT claims with 'still patient' patient status	N/A
11/20/2025	4.0.22	MCR-5-005-16	UPDATE	Specification	STEP 1: Active non-duplicate LT claims during DQ report monthDefine the LT 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, 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 is 'still patient'Of the claims that meet the criteria from STEP 2, count records with1. PATIENT-STATUS = '30'STEP 4: Calculate the percentage for the 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-5-005-16	ADD	N/A		Created

MCR-5-005-16

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements