MCR-62-001-1

Data Quality Measure

Last updated

Key Information

Measure Name	% of claim headers where BILLING-PROV-TAXONOMY does not begin with 27 or 28
File Type	CIP
Measure ID	MCR-62-001-1
Measure Type	Claims Percentage
Content area	MCR

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	High
Focus Area	Managed care
Category	Provider information

Claim Information

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

Thresholds

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

Data Elements

DD Data Element	BILLING-PROV-TAXONOMY
DD Data Element Number	CIP181

Annotation	Calculate the percentage Medicaid and S-CHIP Encounter: original and adjustment, paid IP claims with billing provider taxonomy codes that do not begin with the characters "27" or "28"
Specification	STEP 1: Active non-duplicate paid IP claims during report month Define the IP claims universe at the header level that satisfy the following criteria: 1. Reporting Period from the filename = DQ report month 2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing 3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing 4. TYPE-OF-CLAIM is not equal to "Z" or is missing 5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing 6. 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 and S-CHIP Encounter: Original and Adjustment, Paid Claims Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria: 1. TYPE-OF-CLAIM = "3" or "C" STEP 3: Non-missing billing provider taxonomy Of the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMY STEP 4: Billing provider taxonomy does not begin with 27 or 28 Of the claims that meet the criteria from STEP 3, keep claims where BILLING-PROV-TAXONOMY does not begin with "27" or "28" STEP 5: Calculate percent Divide the count of claims from STEP 4 from STEP 3

Annotation

Calculate the percentage Medicaid and S-CHIP Encounter: original and adjustment, paid IP claims with billing provider taxonomy codes that do not begin with the characters "27" or "28"

Specification

STEP 1: Active non-duplicate paid IP claims during report month

Define the IP claims universe at the header level that satisfy the following criteria:

1. Reporting Period from the filename = DQ report month

2. CLAIM-STATUS-CATEGORY is not equal to "F2" or is missing

3. CLAIM-DENIED-INDICATOR is not equal to "0" or is missing

4. TYPE-OF-CLAIM is not equal to "Z" or is missing

5. CLAIM-STATUS is not equal to ("26","026","87","087","542","585", "654") or is missing

6. 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 and S-CHIP Encounter: Original and Adjustment, Paid Claims

Of the claims that meet the criteria from STEP 1, further restrict them by the following criteria:

1. TYPE-OF-CLAIM = "3" or "C"

STEP 3: Non-missing billing provider taxonomy

Of the claims that meet the criteria from STEP 2, restrict to claims with a non-missing BILLING-PROV-TAXONOMY

STEP 4: Billing provider taxonomy does not begin with 27 or 28

Of the claims that meet the criteria from STEP 3, keep claims where BILLING-PROV-TAXONOMY does not begin with "27" or "28"

STEP 5: Calculate percent

Divide the count of claims from STEP 4 from STEP 3