MCR-57-001-1

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Measure Name	% of claims for which Patient Status is NOT "still a patient" but are missing Discharge Date
File Type	CIP
Measure ID	MCR-57-001-1
Measure Type	Claims Percentage
Content area	MCR

Validation Type	Inferential

Measure Priority	Critical
Focus Area	Managed care
Category	File integrity

Claim Type	CHIP,Enc
Adjustment Type	All Adjustment Types
Crossover Type	All Indicators

Minimum	0
Maximum	0.05
TA Minimun	0
TA Maximum	0.05
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

DD Data Element	PATIENT-STATUS • DISCHARGE-DATE
DD Data Element Number	CIP199 • CIP096

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	MCR-57-001-1	UPDATE	Annotation	The percentage of claims that are S-CHIP Encounter: original and adjustment, and paid where patient status is not "Still a patient" and the discharge date is missing	N/A
11/20/2025	4.0.22	MCR-57-001-1	UPDATE	Specification	STEP 1: Active non-duplicate IP records during DQ report monthDefine the IP records 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: S-CHIP Encounter: Original and Adjustment, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "C"STEP 3: Patient status is not "Still a Patient"Of the claims that meet the criteria from STEP 2, further restrict them by the following criteria: 1. PATIENT-STATUS is not equal to "30"2. PATIENT-STATUS is not missingSTEP 4: Missing discharge dateOf the claims from STEP 3, select records where:1. DISCHARGE-DATE is missingSTEP 5: Calculate percentageDivide the number of claims from STEP 4 by the number of claims from STEP 3	N/A
04/24/2025	4.0.7	MCR-57-001-1	ADD	N/A		Created

MCR-57-001-1

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements