MCR-54-007-7

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Measure Name	# of plans with at least 100 enrollments and some encounters that have OT ratios outside of the expected range (0.1 - 20)
File Type	Multiple Files
Measure ID	MCR-54-007-7
Measure Type	Count
Content area	MCR

Validation Type	Inferential

Measure Priority	Medium
Focus Area	Managed care
Category	Utilization

Claim Type	N/A
Adjustment Type	N/A
Crossover Type	N/A

Minimum	0
Maximum	0
TA Minimun	0
TA Maximum	0
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

DD Data Element	TYPE-OF-SERVICE • OFFSET-TRANS-TYPE • PAYMENT-OR-RECOUPMENT-AMOUNT • PAYEE-MCR-PLAN-TYPE • PAYMENT-AMOUNT • PAYEE-ID-TYPE • MBESCBES-FORM-GROUP • PAYMENT-OR-RECOUPMENT-AMOUNT
DD Data Element Number	COT186 • FTX184 • FTX157 • FTX036 • FTX072 • FTX034 • FTX048 • FTX025

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	MCR-54-007-7	UPDATE	Annotation	Count plan ids in the EL-8-002-2 table with at least 100 enrollments and some encounters that have an encounter OT ratio outside of (0.1, 20), with plan types equal to 01, 04, 05, 06, 07, 08, 09, 10, 11, 12, 13, 14, 15, 16, or 80	N/A
11/20/2025	4.0.22	MCR-54-007-7	UPDATE	Specification	STEP 1: Inclusions Based on Plan TypeOf the Plan_Ids identified in EL-8-002-2, limit to Plan_Ids where:1. Plan_Type_El is equal to ("01","04", "05", "06", "07", "08", "09", "10", "11", "12", "13", "14", "15", "16", or "80")STEP 2: Enrollment and encountersOf the Plan_Ids that meet the criteria in STEP 1, further refine them by keeping those that satisfy the following criteria:1. Enrollment >= 1002. Total_Encounters > 0STEP 3: Encounters OT ratio out of expected rangeOf the Plan_Ids that meet the criteria in STEP 2, count the non-missing Plan_Ids where:1. Encounters_Ot_Ratio < 0.1 OR Encounters_Ot_Ratio > 20	N/A
04/24/2025	4.0.7	MCR-54-007-7	ADD	N/A		Created

MCR-54-007-7

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements