MIS-25-005-5

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Measure Name	% missing: BILLING-PROV-NPI-NUM (COT00002)
File Type	COT
Measure ID	MIS-25-005-5
Measure Type	Claims Percentage
Content area	MIS

Validation Type	Inferential

Measure Priority	Medium
Focus Area	N/A
Category	Provider information

Claim Type	Medicaid,FFS or CHIP,FFS
Adjustment Type	Original and Replacement
Crossover Type	All Indicators

Minimum	0
Maximum	0.3
TA Minimun	0
TA Maximum	0.3
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

DD Data Element	BILLING-PROV-NPI-NUM
DD Data Element Number	COT113

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	MIS-25-005-5	UPDATE	Annotation	Character	N/A
11/20/2025	4.0.22	MIS-25-005-5	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ report monthDefine the OT 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 or S-CHIP FFS: Original and Replacement, Paid ClaimsOf the claims that meet the criteria from STEP 1, further restrict them by the following criteria:1. TYPE-OF-CLAIM = "1" or "A"2. ADJUSTMENT-IND = "0" or "4"STEP 3: Missing data elementOf the claims that meet the criteria from STEP 2, select those whereFor alphanumeric data elements:1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9For numeric data elements: 1. [DATA-ELEMENT-NAME] does not contain any digit 1-9STEP 4: Calculate percentageDivide the count of claims from STEP 3 by the count of claims from STEP 2	N/A
10/07/2025	4.0.19	MIS-25-005-5	UPDATE	Grace period expiration date	None	2023-02-28
04/24/2025	4.0.7	MIS-25-005-5	ADD	N/A		Created

MIS-25-005-5

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements