(MPM) Methodology for Calculating Measure: Administrative Medical Record Hybrid Review Review Element Rating Comments [Met / Needs [Comments only if DENOMINATOR improvement review element is rated needs Population / Not met] improvement or not met.] Medicaid population was appropriately segregated from Met product lines. Members received at least 180 treatment days of ACE/ARB, Met digoxin, or diuretic medications. Geographic Area Includes only Medicaid enrollees served in the MCO’s Met reporting area. Age & Sex: Enrollment Calculation Members are aged 18+ as of December 31 of the Met measurement year. Population was defined as being continuously enrolled during Met the measurement year, with no more than a one-month gap. Data Quality Based on the IS assessment findings, the data sources for this Met denominator were accurate. Appropriate and complete measurement plans and Met programming specifications exist that include data sources, programming logic, and computer source code. Proper Exclusion Methodology in Administrative Data (if no exclusions were taken, mark as N/A) Members who had an inpatient (acute or non-acute) claim Met during the measurement year were excluded (optional exclusion). NUMERATOR Administrative Data: Counting Clinical Events Standard codes listed in NCQA specifications or properly Met mapped internally developed codes were used. All code types were included in analysis, including CPT, ICD10, Met and HCPCS procedures, and UB revenue codes, as relevant. Members were counted only once. Met
(MPM) Methodology for Calculating Measure: Administrative Medical Record Review Hybrid Review Element Rating Comments DENOMINATOR Population [Met / Needs improvement / Not met] [Comments only if review element is rated needs improvement or not met.] Medicaid population was appropriately segregated from product lines. Met Members received at least 180 treatment days of ACE/ARB, digoxin, or diuretic medications. Met Geographic Area Includes only Medicaid enrollees served in the MCO’s reporting area. Met Age & Sex: Enrollment Calculation Members are aged 18+ as of December 31 of the measurement year. Met Population was defined as being continuously enrolled during the measurement year, with no more than a one-month gap. Met Data Quality Based on the IS assessment findings, the data sources for this denominator were accurate. Met Appropriate and complete measurement plans and programming specifications exist that include data sources, programming logic, and computer source code. Met Proper Exclusion Methodology in Administrative Data (if no exclusions were taken, mark as N/A) Members who had an inpatient (acute or non-acute) claim during the measurement year were excluded (optional exclusion). Met NUMERATOR Administrative Data: Counting Clinical Events Standard codes listed in NCQA specifications or properly mapped internally developed codes were used. Met All code types were included in analysis, including CPT, ICD10, and HCPCS procedures, and UB revenue codes, as relevant. Met Members were counted only once. Met
2017-pccp-eqr-technical-report.docx