MCR-59P-003-15

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TMSIS Dataguide

Medicaid.gov

Version:

MCR-59P-003-15

Data Quality Measure

Last updated

Key Information

Measure Name	% of claim headers with PAYMENT-LEVEL-IND = 2 where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header, by Plan ID
File Type	COT
Measure ID	MCR-59P-003-15
Measure Type	Claims Percentage
Content area	MCR
Associated Measure	MCR-59R-003-15

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	N/A
Focus Area	N/A
Category	N/A

Claim Information

Claim Type	Medicaid,Enc or CHIP,Enc
Adjustment Type	Original
Crossover Type	All Indicators

Thresholds

Minimum	0
Maximum	0.01
TA Minimun
TA Maximum
Longitudinal Threshold	N/A
For TA (for including in compliance training)	No
For TA (Longitudinal)	No

Data Elements

DD Data Element	TOT-MEDICAID-PAID-AMT • MEDICAID-PAID-AMT
DD Data Element Number	COT050 • COT178

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	MCR-59P-003-15	UPDATE	Annotation	For each unique Plan ID, calculate the percentage of Medicaid and S-CHIP Encounter: original, paid OT claims that are paid at the line level where the sum of Medicaid paid amount from the lines does not equal the total Medicaid paid amount from the header	N/A
11/20/2025	4.0.22	MCR-59P-003-15	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from 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.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6	N/A
08/13/2025	4.0.16	MCR-59P-003-15	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from 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.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from 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.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJUSTMENT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJUSTMENT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6
05/27/2025	4.0.9	MCR-59P-003-15	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from 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.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 6, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 8, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Managed care enrollment on the last day of DQ report monthOf the MSIS-IDs that meet the criteria from STEP 1, further refine the population using segment MANAGED-CARE-PARTICIPATION-ELG00014 by keeping records that satisfy the following criteria:1a. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE <= last day of the DQ report month2a. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE >= last day of the DQ report month OR missingOR1b. MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE is missing2b. MANAGED-CARE-PLAN-ENROLLMENT-END-DATE is missingSTEP 3: Managed care plans on the last day of DQ report monthDefine the managed care plan population from segment MANAGED-CARE-MAIN-MCR00002 by keeping active records that satisfy the following criteria:1. MANAGED-CARE-MAIN-REC-EFF-DATE <= last day of the reporting month2. MANAGED-CARE-MAIN-REC-END-DATE >= last day of the reporting month OR missingSTEP 4: Active non-duplicate paid OT claims during report monthDefine the OT claims universe at the header level by importing both headers and lines that satisfy the following criteria:For Headers:1. Reporting Period from 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.For Lines:1. Reporting Period from the filename = DQ report month2. CLAIM-LINE-STATUS is not equal to ("26","026","87","087","542","585","654") or is missing3. No Line Duplicates: Duplicates are dropped at the line level if the following data elements are the same: ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, LINE-NUM-ORIG, LINE-NUM-ADJ, and LINE-ADJSTMT-IND.4. Lines merge to a header using ICN-ORIG, ICN-ADJ, ADJUDICATION-DATE, and ADJUSTMENT-IND=LINE-ADJSTMT-IND.STEP 5: Medicaid and S-CHIP Capitation Payment and Encounter: Paid ClaimsOf the claims that meet the criteria from STEP 4, further restrict them by the following criteria:1. TYPE-OF-CLAIM = (“2” or "3" or “B” or "C")STEP 6: Define Plan_IdDefine Plan_Id as a unique list of: MANAGED-CARE-PLAN-ID from the EL file that meet the constraints in STEP 2, STATE-PLAN-ID-NUM from the MCR file that meet the constraints in STEP 3, and PLAN-ID-NUMBER from the claims files that meet the constraints in STEP 5. Also, define a blank Plan_Id for missing.STEP 7: Medicaid and S-CHIP Encounter: Original, Paid ClaimsOf the claims that meet the criteria from STEP 5, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "3" or "C"2. ADJUSTMENT-IND = "0" STEP 8: Exclude sub-capitation encountersOf the claims that meet the criteria from STEP 7, further restrict them by the following criteria:1. SOURCE-LOCATION is NOT equal to "22" or "23"STEP 9: Exclude childless headersOf the claim headers that meet the criteria from STEP 8, drop all headers that do not merge to at least one lineSTEP 10: Claims paid at the line levelOf claims that meet the criteria from STEP 9, further restrict them by the following criteria:1. PAYMENT-LEVEL-IND = "2"STEP 11: Sum Medicaid paid amount from the claim linesOf the claim lines that meet the criteria from STEP 10, sum the MEDICAID-PAID-AMT values to the header levelNote: Missing values are converted to 0 before calculating the sumSTEP 12: Sum does not match total Medicaid paid amountKeep the claims where the sum from STEP 11 does NOT equal the TOT-MEDICAID-PAID-AMT from the header recordNote: Missing values are converted to 0 before comparisonSTEP 13: Calculate the percentage for the measureDivide the count of claims from STEP 12 by the count of claims from STEP 11STEP 14: Repeat for each Plan_IdREPEAT STEPS 7-13 for each Plan_Id identified in STEP 6
04/24/2025	4.0.7	MCR-59P-003-15	ADD	N/A		Created