This variable is the total count of Medicaid other services (OT) (header) claims for the beneficiary after removing the managed care capitated payments.
Comments
CCW filtered the OT claims header records to distinguish between capitated payments and payments for services. Capitated payments are header claims where the claim type code (T-MSIS variable called CLM_TYPE_CD) is equal to '2' (Medicaid or expansion claim) 'B' (S-CHIP claim) or 'V' (Other Services claim). These capitated payment claims are captured in MMLEADS in the MDCD_OT_MC_PREMIUM_USE variable.
The Medicaid payment information corresponding to this variable is in the MDCD_OT_TOTAL_SPEND variable; however, due to CMS payment redaction requirements the dollar totals will not reflect the (redacted) managed care expenditures. MMLEADS counts all claims in the MDCD_OT_TOTAL_USE variable. Use caution when calculating average spend per claim. There may be claims (i.e., use) for which there is no corresponding payment information.
Source: T-MSIS Other Services Claims file (derived)
CCW filtered the OT claims header records to distinguish between capitated payments and payments for services. Capitated payments are header claims where the claim type code (T-MSIS variable called CLM_TYPE_CD) is equal to '2' (Medicaid or expansion claim) 'B' (S-CHIP claim) or 'V' (Other Services claim). These capitated payment claims are captured in MMLEADS in the MDCD_OT_MC_PREMIUM_USE variable.
The Medicaid payment information corresponding to this variable is in the MDCD_OT_TOTAL_SPEND variable; however, due to CMS payment redaction requirements the dollar totals will not reflect the (redacted) managed care expenditures. MMLEADS counts all claims in the MDCD_OT_TOTAL_USE variable. Use caution when calculating average spend per claim. There may be claims (i.e., use) for which there is no corresponding payment information.
Source: T-MSIS Other Services Claims file (derived)