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Measure Name | % of Submitting State Provider IDs with FACILITY-GROUP-INDIVIDUAL-CODE = 01, 02 (facility or group) that do not have a Provider Classification Code that indicates a facility or group |
---|---|
File Type | PRV |
Measure ID | PRV-6-001-1 |
Measure Type | Non-claims percentage |
Content area | PRO |
Validation Type | Inferential |
---|
Measure Priority | Medium |
---|---|
Focus Area | N/A |
Category | Provider identifiers |
Claim Type | N/A |
---|---|
Adjustment Type | N/A |
Crossover Type | N/A |
Minimum | 0 |
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Maximum | 0.2 |
TA Minimun | 0 |
TA Maximum | 0.2 |
Longitudinal Threshold | N/A |
For TA
(for including in compliance training) |
TA- Inferential |
For TA
(Longitudinal) |
No |
DD Data Element | FACILITY-GROUP-INDIVIDUAL-CODE • SUBMITTING-STATE-PROV-ID • PROV-CLASSIFICATION-CODE • PROV-CLASSIFICATION-TYPE |
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DD Data Element Number | PRV026 • PRV019 • PRV089 • PRV088 |
Annotation | Calculate the percentage of submitting state provider IDs that have a facility group individual code indicating facility or group but whose provider classification code does not indicate facility or group |
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Specification |
STEP 1: Provider enrolled on the last day of DQ report month Define the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria: 1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month 2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing 3. SUBMITTING-STATE-PROV-ID is not missing STEP 2: Provider attributes are active on last day of DQ report month Of the providers that meet the criteria from STEP 1, further refine the population using segment PROVIDER-ATTRIBUTES-MAIN- PRV00002 by keeping records that satisfy the following criteria: 1. PROV-ATTRIBUTES-EFF-DATE <= last day of the reporting month 2. PROV-ATTRIBUTES-END-DATE >= last day of the reporting month or missing 3. SUBMITTING-STATE-PROV-ID is not missing STEP 3: Provider is a facility or group Of the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria: 1. FACILITY-GROUP-INDIVIDUAL-CODE = "01" or "02" STEP 4: Provider taxonomy is active on the last day of DQ report month Of the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria: 1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month 2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missing OR 1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing 2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missing STEP 5: Provider Classification Lookup Designation is "Individual" or missing Of the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 4, further refine the population by keeping records that meet the following criteria: 1a. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Provider Classification lookup table AND 1b. Provider Classification Lookup Designation is never “Non-Individual” OR 2. PROV-IDENTIFIER-TYPE and PROVIDER-CLASSIFICATION-CODE are never equal to values in Provider Classification lookup table OR 3. PROV-IDENTIFIER-TYPE is always missing OR 4. PROVIDER-CLASSIFICATION-CODE is always missing STEP 6: Calculate percentage Divide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 5 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 3 |