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data | 6 | 72 | 36 | New York | Expenditure Benchmarking | Total Monthly Beneficiary Payments | 2016 | Low concern | Percent difference in total monthly Medicaid beneficiary payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data | -3.1 | TAF | Release 1 |
data | 6 | 73 | 36 | New York | Expenditure Benchmarking | CMC Payments | 2016 | High concern | Percent difference in comprehensive managed care (CMC) capitation payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data | -26.2 | TAF | Release 1 |
data | 6 | 74 | 36 | New York | Expenditure Benchmarking | PHP Payments | 2016 | Unusable | Percent difference in prepaid health plan (PHP) capitation payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data | 4,129.2 | TAF | Release 1 |
data | 6 | 75 | 36 | New York | Expenditure Benchmarking | PCCM Fees | 2016 | Unclassified | Percent difference in primary care case management plan (PCCM) fees between the T-MSIS Analytic Files (TAF) and the CMS-64 data | Not applicable | TAF | Release 1 |
data | 6 | 76 | 36 | New York | Expenditure Benchmarking | Premium Assistance Payments | 2016 | Unusable | Percent difference in premium assistance payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data | 109.1 | TAF | Release 1 |
data | 6 | 66 | 36 | New York | Payments | Missing Payment Data - FFS Claims | 2016 | Low concern | Percentage of fee-for-service (FFS) claims with a zero, missing, or negative payment amount in the T-MSIS Analytic Files (TAF) | 0.8 | TAF | Release 1 |
data | 6 | 81 | 36 | New York | Payments | Payment Data Consistency - IP | 2016 | Low concern | Multiple criteria: (1) Percentage of fee-for-service (FFS) inpatient (IP) claims with a header payment equal to the sum of its associated claim line payments and (2) percentage of IP claims with an unknown payment level in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 80 | 36 | New York | Payments | Payment Data Consistency - LT | 2016 | Low concern | Multiple criteria: (1) Percentage of fee-for-service (FFS) long-term care (LT) claims with a header payment equal to the sum of its associated claim line payments and (2) percentage of LT claims with an unknown payment level in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 79 | 36 | New York | Payments | Payment Data Consistency - OT | 2016 | Low concern | Multiple criteria: (1) Percentage of fee-for-service (FFS) other service (OT) claims with a header payment equal to the sum of its associated claim line payments and (2) percentage of OT claims with an unknown payment level in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 78 | 36 | New York | Payments | Payment Data Consistency - RX | 2016 | Low concern | Multiple criteria: (1) Percentage of fee-for-service (FFS) pharmacy (RX) claims with a header payment equal to the sum of its associated claim line payments and (2) percentage of RX claims with an unknown payment level in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 49 | 36 | New York | Service Use Information | Diagnosis Code - IP | 2016 | Low concern | Percentage of inpatient (IP) header records with a valid ICD-10 primary diagnosis code in the T-MSIS Analytic Files (TAF) | 100.0 | TAF | Release 1 |
data | 6 | 50 | 36 | New York | Service Use Information | Diagnosis Code - LT | 2016 | Low concern | Percentage of long-term care (LT) header records with a valid ICD-10 primary diagnosis code in the T-MSIS Analytic Files (TAF) | 100.0 | TAF | Release 1 |
data | 6 | 51 | 36 | New York | Service Use Information | Diagnosis Code - OT | 2016 | Low concern | Percentage of other service (OT) header records for outpatient hospital services, physician services, or clinic services with a valid ICD-10 primary diagnosis code in the T-MSIS Analytic Files (TAF) | 100.0 | TAF | Release 1 |
data | 6 | 65 | 36 | New York | Service Use Information | Procedure Codes - IP | 2016 | Low concern | Multiple criteria: (1) Percentage of inpatient (IP) header records with a missing primary procedure code, and (2) the percentage of IP header records with any invalid procedure codes in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 63 | 36 | New York | Service Use Information | Procedure Codes - OT Professional | 2016 | Medium concern | Percentage of all other service (OT) professional claim line records with missing or invalid values in the procedure code field in the T-MSIS Analytic Files (TAF) | 18.6 | TAF | Release 1 |
data | 6 | 64 | 36 | New York | Service Use Information | Procedure Codes - OT Institutional | 2016 | Unusable | Percentage of all other service (OT) institutional claim line records with missing or invalid values in the procedure code field in the T-MSIS Analytic Files (TAF) | 100.0 | TAF | Release 1 |
data | 6 | 52 | 36 | New York | Service Use Information | Type of Service - IP | 2016 | Low concern | Percentage of inpatient (IP) claim line records with a missing or invalid type of service (TOS) code in the T-MSIS Analytic Files (TAF) | 0.0 | TAF | Release 1 |
data | 6 | 54 | 36 | New York | Service Use Information | Type of Service - LT | 2016 | Low concern | Percentage of long-term care (LT) claim line records with a missing or invalid type of service (TOS) code in the T-MSIS Analytic Files (TAF) | 0.0 | TAF | Release 1 |
data | 6 | 53 | 36 | New York | Service Use Information | Type of Service - OT | 2016 | Low concern | Percentage of other service (OT) claim line records with a missing or invalid type of service (TOS) code in the T-MSIS Analytic Files (TAF) | 0.0 | TAF | Release 1 |
data | 6 | 55 | 36 | New York | Service Use Information | Type of Service - RX | 2016 | Low concern | Percentage of pharmacy (RX) claim line records with a missing or invalid type of service code (TOS) in the T-MSIS Analytic Files (TAF) | 0.0 | TAF | Release 1 |
data | 6 | 62 | 36 | New York | Service Use Information | Place of Service | 2016 | Medium concern | Percentage of all other service (OT) header records with the expected combination of type of bill (TOB) code and place of service code (POS) in the T-MSIS Analytic Files (TAF) | 75.8 | TAF | Release 1 |
data | 6 | 41 | 36 | New York | Service Use Information | Admission Date - IP | 2016 | Low concern | Percentage of inpatient (IP) records with a missing or invalid admission date in the T-MSIS Analytic Files (TAF) | 0.8 | TAF | Release 1 |
data | 6 | 42 | 36 | New York | Service Use Information | Admission Date - LT | 2016 | Medium concern | Percentage of long-term care (LT) records with a missing or invalid admission date in the T-MSIS Analytic Files (TAF) | 19.3 | TAF | Release 1 |
data | 6 | 43 | 36 | New York | Service Use Information | Discharge Date - IP | 2016 | Low concern | Percentage of inpatient (IP) records with an unexpectedly missing or invalid discharge date in the T-MSIS Analytic Files (TAF) | 0.4 | TAF | Release 1 |
data | 6 | 44 | 36 | New York | Service Use Information | Discharge Date - LT | 2016 | Low concern | Multiple criteria: Percentage of long-term care (LT) records with (1) a missing discharge date and (2) an unexpectedly missing or invalid discharge date in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 23 | 36 | New York | Service Use Information | Type of Bill - IP | 2016 | Medium concern | Percentage of inpatient (IP) claim header records with an expected type of bill code in the T-MSIS Analytic Files (TAF) | 81.8 | TAF | Release 1 |
data | 6 | 24 | 36 | New York | Service Use Information | Type of Bill - LT | 2016 | Unusable | Percentage of long-term care (LT) claim header records with an expected type of bill code in the T-MSIS Analytic Files (TAF) | 23.1 | TAF | Release 1 |
data | 6 | 25 | 36 | New York | Service Use Information | Type of Bill - OT | 2016 | Low concern | Multiple criteria: (1) Percentage of other service (OT) claim header records with an unexpected or invalid type of bill code and (2) percentage of OT claim header records with a missing type of bill code in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 40 | 36 | New York | Service Use Information | Generic Indicator - RX | 2016 | Low concern | Multiple criteria: See Background and Methods | See Background and Methods | TAF | Release 1 |
data | 6 | 60 | 36 | New York | Non-Claim Records | Supplemental Payments | 2016 | Low concern | Multiple criteria: See Background and Methods | See Background and Methods | TAF | Release 1 |
data | 6 | 61 | 36 | New York | Non-Claim Records | Non-Program (Other) Claims | 2016 | Low concern | Percentage of claim records with other, non-program claim type code in the T-MSIS Analytic Files (TAF) | 0.0 | TAF | Release 1 |
data | 6 | 33 | 36 | New York | Provider Information | Billing Provider NPI - IP | 2016 | Low concern | Percentage of records in the IP file with a missing billing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF) | 0.4 | TAF | Release 1 |
data | 6 | 34 | 36 | New York | Provider Information | Billing Provider NPI - LT | 2016 | High concern | Percentage of records in the LT file with a missing billing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF) | 27.5 | TAF | Release 1 |
data | 6 | 35 | 36 | New York | Provider Information | Billing Provider NPI - OT | 2016 | High concern | Percentage of records in the OT file with a missing billing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF) | 20.3 | TAF | Release 1 |
data | 6 | 36 | 36 | New York | Provider Information | Billing Provider NPI - RX | 2016 | Low concern | Percentage of records in the RX file with a missing billing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF) | 0.1 | TAF | Release 1 |
data | 6 | 30 | 36 | New York | Provider Information | Servicing Provider NPI - OT | 2016 | Medium concern | Percentage of other service (OT) line records with a missing servicing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF) | 12.9 | TAF | Release 1 |
data | 6 | 31 | 36 | New York | Provider Information | Prescribing Provider NPI - RX | 2016 | Low concern | Percentage of pharmacy (RX) header records with a missing prescribing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF) | 0.0 | TAF | Release 1 |
data | 6 | 32 | 36 | New York | Provider Information | Dispensing Provider NPI - RX | 2016 | Unusable | Percentage of pharmacy (RX) header records with a missing dispensing provider National Provider Identifier (NPI) in the T-MSIS Analytic Files (TAF) | 93.1 | TAF | Release 1 |
data | 6 | 37 | 36 | New York | Provider Information | Billing Provider Type, Specialty, and Taxonomy - IP | 2016 | Unusable | Percentage of inpatient (IP) header records with an expected billing provider type, specialty, state-reported taxonomy, or NPPES taxonomy code in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 38 | 36 | New York | Provider Information | Billing Provider Type, Specialty, and Taxonomy - LT | 2016 | Unusable | Percentage of long-term care (LT) header records with an expected billing provider type, specialty, state-reported taxonomy, or NPPES primary taxonomy code in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 104 | 36 | New York | Provider Information | Billing Provider Type, Specialty, and Taxonomy - OT Professional | 2016 | Medium concern | Percentage of header records on other service (OT) professional claims with a valid billing provider type, specialty, state-reported taxonomy, or NPPES primary taxonomy code in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 105 | 36 | New York | Provider Information | Billing Provider Type, Specialty, and Taxonomy - OT Institutional | 2016 | Medium concern | Percentage of header records on other service (OT) institutional claims with a valid billing provider type, specialty, state-reported taxonomy, or NPPES primary taxonomy code in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 26 | 36 | New York | Provider Information | Hospital Type - IP | 2016 | Unusable | Percentage of inpatient (IP) claim header records with an expected type of hospital code in the T-MSIS Analytic Files (TAF) | 0.2 | TAF | Release 1 |
data | 6 | 7 | 37 | North Carolina | Enrollment Benchmarking | Total Medicaid and CHIP Enrollment | 2016 | Low concern | Average monthly percent difference in the count of Medicaid and CHIP beneficiaries with comprehensive benefits between the T-MSIS Analytic Files (TAF) and Performance Indicator (PI) data | -7.9 | TAF | Release 1 |
data | 6 | 8 | 37 | North Carolina | Enrollment Benchmarking | Medicaid-Only Enrollment | 2016 | Low concern | Average monthly percent difference in the count of Medicaid beneficiaries with comprehensive benefits between the T-MSIS Analytic Files (TAF) and Performance Indicator (PI) data | -8.5 | TAF | Release 1 |
data | 6 | 4 | 37 | North Carolina | Enrollment Benchmarking | M-CHIP and S-CHIP Enrollment | 2016 | Low concern | Average monthly percent difference in CHIP enrollment between the T-MSIS Analytic Files (TAF) and Performance Indicator (PI) data | -1.8 | TAF | Release 1 |
data | 6 | 9 | 37 | North Carolina | Enrollment Benchmarking | Dually Enrolled in Medicare | 2016 | Low concern | Average percent difference in the count of dually eligible beneficiaries in March, June, September, and December between the T-MSIS Analytic Files (TAF) and Medicare Modernization Act (MMA) data | 3.3 | TAF | Release 1 |
data | 6 | 1 | 37 | North Carolina | Enrollment Benchmarking | Enrollment in CMC Plans | 2016 | Unclassified | Percent difference in comprehensive managed care (CMC) organization enrollment between the T-MSIS Analytic Files (TAF) and the Medicaid Managed Care Enrollment and Program Characteristics (MMCEPC) report | Not applicable | TAF | Release 1 |
data | 6 | 2 | 37 | North Carolina | Enrollment Benchmarking | Enrollment in PCCM Programs | 2016 | Low concern | Percent difference in primary care case management (PCCM) enrollment between the T-MSIS Analytic Files (TAF) and the Medicaid Managed Care Enrollment and Program Characteristics (MMCEPC) report | 0.6 | TAF | Release 1 |
data | 6 | 3 | 37 | North Carolina | Enrollment Benchmarking | Enrollment in BHO Plans | 2016 | Low concern | Percent difference in behavioral health organization (BHO) enrollment between the T-MSIS Analytic Files (TAF) and the Medicaid Managed Care Enrollment and Program Characteristics (MMCEPC) report | -5.2 | TAF | Release 1 |
data | 6 | 5 | 37 | North Carolina | Enrollment Benchmarking | Adult Expansion Enrollment | 2016 | Unclassified | Average monthly percent difference in adult expansion group enrollment between the T-MSIS Analytic Files (TAF) and the Medicaid Budget and Expenditure System (MBES) data | Not applicable | TAF | Release 1 |
data | 6 | 6 | 37 | North Carolina | Enrollment Benchmarking | Newly Eligible Adult Enrollment | 2016 | Unclassified | Average monthly percent difference in 'newly eligible' adult expansion group enrollment between the T-MSIS Analytic Files (TAF) and the Medicaid Budget and Expenditure System (MBES) data | Not applicable | TAF | Release 1 |
data | 6 | 82 | 37 | North Carolina | Enrollment Benchmarking | 1915(c) Participation | 2016 | Unusable | Multiple criteria: (1) Percentage of total Medicaid beneficiaries in TAF particpating in 1915(c) waivers and (2) alignment of participant reporting in TAF with 1915(c) waiver status | 6,472.6 | TAF | Release 1 |
data | 6 | 10 | 37 | North Carolina | Enrollment Patterns Over Time | Number of Enrollment Spans | 2016 | Medium concern | Multiple criteria: (1) Percentage of Medicaid and CHIP beneficiaries with only one enrollment span during the calendar year and (2) percentage of beneficiaries with three or more enrollment spans during the calendar year in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 11 | 37 | North Carolina | Enrollment Patterns Over Time | Length of Enrollment Gaps | 2016 | Low concern | Multiple criteria: (1) Average length of enrollment gap (in days) for Medicaid and CHIP beneficiaries with an enrollment gap and (2) percentage of beneficiaries with an enrollment gap in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 12 | 37 | North Carolina | Enrollment Patterns Over Time | Overlapping Enrollment Spans | 2016 | Low concern | Percentage of beneficiaries with overlapping Medicaid and S-CHIP enrollment spans in the T-MSIS Analytic Files (TAF) | 0.0 | TAF | Release 1 |
data | 6 | 13 | 37 | North Carolina | Beneficiary Information | Age | 2016 | Low concern | Percentage of beneficiaries missing age values in the T-MSIS Analytic Files (TAF) | 0.0 | TAF | Release 1 |
data | 6 | 14 | 37 | North Carolina | Beneficiary Information | Gender | 2016 | Low concern | Percentage of beneficiaries missing gender values in the T-MSIS Analytic Files (TAF) | 0.0 | TAF | Release 1 |
data | 6 | 16 | 37 | North Carolina | Beneficiary Information | Race and Ethnicity | 2016 | Low concern | Multiple criteria: (1) Percentage of beneficiaries missing race and/or ethnicity values in the T-MSIS Analytic Files (TAF) and (2) the number of race/ethnicity categories (out of 6) with a percentage point difference greater than 10 between the TAF and American Community Survey (ACS) data | See Background and Methods | TAF | Release 1 |
data | 6 | 17 | 37 | North Carolina | Beneficiary Information | Income | 2016 | Low concern | Percentage of beneficiaries missing family income values in the T-MSIS Analytic Files (TAF) | 0.0 | TAF | Release 1 |
data | 6 | 15 | 37 | North Carolina | Beneficiary Information | ZIP Code | 2016 | Low concern | Percentage of beneficiaries missing ZIP code values in the T-MSIS Analytic Files (TAF) | 1.4 | TAF | Release 1 |
data | 6 | 20 | 37 | North Carolina | Beneficiary Information | Eligibility Group Code | 2016 | Medium concern | Multiple criteria: (1) Percentage of beneficiaries missing an eligibility group code and (2) the number of large mandatory eligibility groups with no enrollment in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 18 | 37 | North Carolina | Beneficiary Information | Dual Eligibility Code | 2016 | Low concern | Multiple criteria: See Background and Methods | See Background and Methods | TAF | Release 1 |
data | 6 | 19 | 37 | North Carolina | Beneficiary Information | CHIP Code | 2016 | Low concern | Multiple criteria: See Background and Methods | See Background and Methods | TAF | Release 1 |
data | 6 | 21 | 37 | North Carolina | Beneficiary Information | Restricted Benefits Code | 2016 | Low concern | Percentage of Medicaid and CHIP beneficiaries with a known benefit type in the restricted benefits code field in the T-MSIS Analytic Files (TAF) | 99.2 | TAF | Release 1 |
data | 6 | 45 | 37 | North Carolina | Claim Files Completeness | Claims Volume - IP | 2016 | Low concern | Multiple criteria: (1) Total inpatient (IP) header volume as a percentage of the national median, (2) IP line volume as a percentage of the national median, and (3) average number of IP line records per header as a percentage of the national median in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 46 | 37 | North Carolina | Claim Files Completeness | Claims Volume - LT | 2016 | Low concern | Average number of long-term care (LT) line records per header as a percentage of the national median in the T-MSIS Analytic Files (TAF) | 237.8 | TAF | Release 1 |
data | 6 | 47 | 37 | North Carolina | Claim Files Completeness | Claims Volume - OT | 2016 | Low concern | Multiple criteria: (1) Total other service (OT) header volume as a percentage of the national median, (2) total OT line volume as a percentage of the national median, and (3) average number of OT line records per header as a percentage of the national median in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 48 | 37 | North Carolina | Claim Files Completeness | Claims Volume - RX | 2016 | Medium concern | Multiple criteria: (1) Total pharmacy (RX) header volume as a percentage of the national median, (2) total RX line volume as a percentage of the national median, and (3) average number of RX line records per header as a percentage of the national median in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 27 | 37 | North Carolina | Claim Files Completeness | Service Users - IP | 2016 | Low concern | Percentage of non-dually eligible beneficiaries with at least one inpatient (IP) claim record in the T-MSIS Analytic Files (TAF), as a proportion of the national median | 118.0 | TAF | Release 1 |
data | 6 | 28 | 37 | North Carolina | Claim Files Completeness | Service Users - OT | 2016 | Low concern | Percentage of non-dually eligible beneficiaries with at least one other service (OT) claim record in the T-MSIS Analytic Files (TAF), as a proportion of the national median | 103.9 | TAF | Release 1 |
data | 6 | 29 | 37 | North Carolina | Claim Files Completeness | Service Users - RX | 2016 | Low concern | Percentage of non-dually eligible beneficiaries with at least one pharmacy (RX) claim record in the T-MSIS Analytic Files (TAF), as a proportion of the national median | 98.3 | TAF | Release 1 |
data | 6 | 56 | 37 | North Carolina | Claim Files Completeness | CMC Plan Encounters - IP | 2016 | Unclassified | Multiple criteria: (1) Inpatient (IP) comprehensive managed care (CMC) encounter header record volume as a percentage of the national median, (2) IP CMC encounter line record volume as a percentage of the national median, (3) the average number of IP CMC encounter line records per header as a percentage of the national median, and (4) the number of CMC plans with no IP encounter header records in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 57 | 37 | North Carolina | Claim Files Completeness | CMC Plan Encounters - LT | 2016 | Unclassified | Multiple criteria: (1) The average number of long-term care (LT) comprehensive managed care (CMC) encounter line records per LT claim header as a percentage of the national median and (2) the number of CMC plans with no LT encounter header records in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 58 | 37 | North Carolina | Claim Files Completeness | CMC Plan Encounters - OT | 2016 | Unclassified | Multiple criteria: (1) Other service (OT) comprehensive managed care (CMC) encounter header record volume as a percentage of the national median, (2) volume of OT CMC encounter line records as a percentage of the national median, (3) the average number of OT CMC line records per header as a percentage of the national median, and (4) the number of CMC plans with no OT encounter header records in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 59 | 37 | North Carolina | Claim Files Completeness | CMC Plan Encounters - RX | 2016 | Unclassified | Multiple criteria: (1) The average number of pharmacy (RX) comprehensive managed care (CMC) encounter line records per RX claim header as a percentage of the national median and (2) the number of CMC plans with no RX encounter header records in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 22 | 37 | North Carolina | Claim Files Completeness | Benchmarking Inpatient Stays - IP | 2016 | Unusable | Percent difference in adult inpatient hospital stays between the T-MSIS Analytic Files (TAF) and the Healthcare Cost and Utilization Project (HCUP) data | -100.0 | TAF | Release 1 |
data | 6 | 77 | 37 | North Carolina | Expenditure Benchmarking | Total Medicaid Expenditures | 2016 | Medium concern | Percent difference in total Medicaid expenditures for medical assistance programs between the T-MSIS Analytic Files (TAF) and the CMS-64 data | -15.7 | TAF | Release 1 |
data | 6 | 67 | 37 | North Carolina | Expenditure Benchmarking | Total FFS Expenditures | 2016 | High concern | Percent difference in Medicaid fee-for-service (FFS) expenditures between the T-MSIS Analytic Files (TAF) and the CMS-64 data | -25.7 | TAF | Release 1 |
data | 6 | 68 | 37 | North Carolina | Expenditure Benchmarking | FFS Inpatient Expenditures | 2016 | High concern | Percent difference in Medicaid fee-for-service (FFS) expenditures for inpatient hospital services between the T-MSIS Analytic Files (TAF) and the CMS-64 data | -47.5 | TAF | Release 1 |
data | 6 | 69 | 37 | North Carolina | Expenditure Benchmarking | FFS Long-Term Care Expenditures | 2016 | High concern | Percent difference in Medicaid fee-for-service (FFS) expenditures for institutional long-term care services between the T-MSIS Analytic Files (TAF) and the CMS-64 data | -30.8 | TAF | Release 1 |
data | 6 | 70 | 37 | North Carolina | Expenditure Benchmarking | FFS Other Medical Expenditures | 2016 | Medium concern | Percent difference in Medicaid fee-for-service (FFS) expenditures for all other medical services between the T-MSIS Analytic Files (TAF) and the CMS-64 data | -14.8 | TAF | Release 1 |
data | 6 | 71 | 37 | North Carolina | Expenditure Benchmarking | FFS Prescription Drug Expenditures | 2016 | High concern | Percent difference in Medicaid fee-for-service (FFS) expenditures for prescription drugs between the T-MSIS Analytic Files (TAF) and the CMS-64 data | -26.8 | TAF | Release 1 |
data | 6 | 72 | 37 | North Carolina | Expenditure Benchmarking | Total Monthly Beneficiary Payments | 2016 | High concern | Percent difference in total monthly Medicaid beneficiary payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data | 25.4 | TAF | Release 1 |
data | 6 | 73 | 37 | North Carolina | Expenditure Benchmarking | CMC Payments | 2016 | Unclassified | Percent difference in comprehensive managed care (CMC) capitation payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data | Not applicable | TAF | Release 1 |
data | 6 | 74 | 37 | North Carolina | Expenditure Benchmarking | PHP Payments | 2016 | High concern | Percent difference in prepaid health plan (PHP) capitation payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data | 26.3 | TAF | Release 1 |
data | 6 | 75 | 37 | North Carolina | Expenditure Benchmarking | PCCM Fees | 2016 | High concern | Percent difference in primary care case management plan (PCCM) fees between the T-MSIS Analytic Files (TAF) and the CMS-64 data | 27.9 | TAF | Release 1 |
data | 6 | 76 | 37 | North Carolina | Expenditure Benchmarking | Premium Assistance Payments | 2016 | Unusable | Percent difference in premium assistance payments between the T-MSIS Analytic Files (TAF) and the CMS-64 data | -100.0 | TAF | Release 1 |
data | 6 | 66 | 37 | North Carolina | Payments | Missing Payment Data - FFS Claims | 2016 | Low concern | Percentage of fee-for-service (FFS) claims with a zero, missing, or negative payment amount in the T-MSIS Analytic Files (TAF) | 1.3 | TAF | Release 1 |
data | 6 | 81 | 37 | North Carolina | Payments | Payment Data Consistency - IP | 2016 | Low concern | Multiple criteria: (1) Percentage of fee-for-service (FFS) inpatient (IP) claims with a header payment equal to the sum of its associated claim line payments and (2) percentage of IP claims with an unknown payment level in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 80 | 37 | North Carolina | Payments | Payment Data Consistency - LT | 2016 | Low concern | Multiple criteria: (1) Percentage of fee-for-service (FFS) long-term care (LT) claims with a header payment equal to the sum of its associated claim line payments and (2) percentage of LT claims with an unknown payment level in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 79 | 37 | North Carolina | Payments | Payment Data Consistency - OT | 2016 | Low concern | Multiple criteria: (1) Percentage of fee-for-service (FFS) other service (OT) claims with a header payment equal to the sum of its associated claim line payments and (2) percentage of OT claims with an unknown payment level in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 78 | 37 | North Carolina | Payments | Payment Data Consistency - RX | 2016 | Low concern | Multiple criteria: (1) Percentage of fee-for-service (FFS) pharmacy (RX) claims with a header payment equal to the sum of its associated claim line payments and (2) percentage of RX claims with an unknown payment level in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 49 | 37 | North Carolina | Service Use Information | Diagnosis Code - IP | 2016 | Low concern | Percentage of inpatient (IP) header records with a valid ICD-10 primary diagnosis code in the T-MSIS Analytic Files (TAF) | 100.0 | TAF | Release 1 |
data | 6 | 50 | 37 | North Carolina | Service Use Information | Diagnosis Code - LT | 2016 | Low concern | Percentage of long-term care (LT) header records with a valid ICD-10 primary diagnosis code in the T-MSIS Analytic Files (TAF) | 100.0 | TAF | Release 1 |
data | 6 | 51 | 37 | North Carolina | Service Use Information | Diagnosis Code - OT | 2016 | Low concern | Percentage of other service (OT) header records for outpatient hospital services, physician services, or clinic services with a valid ICD-10 primary diagnosis code in the T-MSIS Analytic Files (TAF) | 99.7 | TAF | Release 1 |
data | 6 | 65 | 37 | North Carolina | Service Use Information | Procedure Codes - IP | 2016 | Low concern | Multiple criteria: (1) Percentage of inpatient (IP) header records with a missing primary procedure code, and (2) the percentage of IP header records with any invalid procedure codes in the T-MSIS Analytic Files (TAF) | See Background and Methods | TAF | Release 1 |
data | 6 | 63 | 37 | North Carolina | Service Use Information | Procedure Codes - OT Professional | 2016 | Low concern | Percentage of all other service (OT) professional claim line records with missing or invalid values in the procedure code field in the T-MSIS Analytic Files (TAF) | 0.0 | TAF | Release 1 |
data | 6 | 64 | 37 | North Carolina | Service Use Information | Procedure Codes - OT Institutional | 2016 | Low concern | Percentage of all other service (OT) institutional claim line records with missing or invalid values in the procedure code field in the T-MSIS Analytic Files (TAF) | 10.2 | TAF | Release 1 |
data | 6 | 52 | 37 | North Carolina | Service Use Information | Type of Service - IP | 2016 | Low concern | Percentage of inpatient (IP) claim line records with a missing or invalid type of service (TOS) code in the T-MSIS Analytic Files (TAF) | 0.0 | TAF | Release 1 |
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