MCR-62-006-6

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Measure Name	% of claim headers where TYPE-OF-BILL does not begin with 02 (nursing facility) or 06 (ICF)
File Type	CLT
Measure ID	MCR-62-006-6
Measure Type	Claims Percentage
Content area	MCR

Validation Type	Inferential

Measure Priority	High
Focus Area	Managed care
Category	Utilization

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

Minimum	0
Maximum	0.1
TA Minimun	0
TA Maximum	0.1
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

DD Data Element	TYPE-OF-BILL
DD Data Element Number	CLT053

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	MCR-62-006-6	UPDATE	Annotation	Calculate the percent of Medicaid and S-CHIP: Encounter, original and adjustment, paid LT claims where type of bill does not begin with the value for "nursing facility" or "ICF"	N/A
11/20/2025	4.0.22	MCR-62-006-6	UPDATE	Specification	STEP 1: Active non-duplicate paid LT claims during report monthDefine the LT claims universe at the header level that satisfy the following criteria: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.STEP 2: Medicaid and 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 = "3" or "C"STEP 3: Non-missing type of billOf the claims that meet the criteria from STEP 2, restrict to non-missing TYPE-OF-BILLSTEP 4: Count of claims with an invalid type of billOf the claims that meet the criteria from STEP 3, count claims where TYPE-OF-BILL does not begin with "02" or "06"STEP 5: Calculate percentDivide the count from STEP 4 by the count from STEP 3	N/A
04/24/2025	4.0.7	MCR-62-006-6	ADD	N/A		Created

MCR-62-006-6

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements