Identifying Service Setting in 2017 (Brief)
T-MSIS Analytic Files Data Quality Brief #5192
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Associated Project
Providing Business Analytics and Data Quality Development for Medicaid and CHIP Business Information Solutions (MACBIS)
Prepared for:
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services
Key Findings
- Users of the T-MSIS Analytic Files (TAF) who investigate service use in the Medicaid program will often need to determine the setting where services were delivered. This brief describes the extent to which TAF users will have the information they need to determine service setting in the OT file.
- The OT file contains both institutional and professional claims for services delivered in a variety of settings. The type of bill code should be used to determine service setting on institutional claims, while the place of service code should be used to determine service setting on professional claims. When neither or both of these variables are available, TAF users can identify the service setting indirectly.
- For 33 states, the level of data quality concern with respect to identifying the service setting is low. For 10 states, the level of concern is medium. For 5 states, it is high.
- Among the claims for which service setting could only be identified indirectly, the most frequently occurring data quality issues were a missing or invalid type of bill code and a missing or invalid place of service code. In most cases, there was no valid revenue center code on these claims, which means TAF users will be unable to determine the service setting.
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