MIS-26-027-27

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TMSIS Dataguide

Medicaid.gov

Version:

MIS-26-027-27

Data Quality Measure

Last updated

Key Information

Measure Name	% missing: SERVICING-PROV-NUM (COT00003)
File Type	COT
Measure ID	MIS-26-027-27
Measure Type	Claims Percentage
Content area	MIS

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	Medium
Focus Area	N/A
Category	Provider information

Claim Information

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

Thresholds

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

Data Elements

DD Data Element	SERVICING-PROV-NUM
DD Data Element Number	COT189

Annotation

Character

Specification

STEP 1: Active non-duplicate OT claims during DQ report month

Define 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 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.

For Lines:

1. Reporting Period from the filename = DQ report month

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

3. 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 2: Medicaid and S-CHIP FFS: Original and Replacement, Paid Claims

Of 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 element

Of the claims that meet the criteria from STEP 2, select those where

For alphanumeric data elements:

1. [DATA-ELEMENT-NAME] does not contain any alpha character (A-Z or a-z) OR any digit 1-9

For numeric data elements:

1. [DATA-ELEMENT-NAME] does not contain any digit 1-9

STEP 4: Calculate percentage

Divide the count of claim lines from STEP 3 by the count of claim lines from STEP 2

Published Date	Data Guide Version	DQM	Action	Field	Before	After
08/13/2025	4.0.16	MIS-26-027-27	UPDATE	Specification	STEP 1: Active non-duplicate OT claims during DQ 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 2: Medicaid and 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 claim lines from STEP 3 by the count of claim lines from STEP 2	STEP 1: Active non-duplicate OT claims during DQ 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 2: Medicaid and 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 claim lines from STEP 3 by the count of claim lines from STEP 2
04/24/2025	4.0.7	MIS-26-027-27	ADD	N/A		Created