Note: Export, save, and print all results for audit purposes at the time you run them for actual volume validation.
A sample image of this SQL report run in the Database Viewer is shown below:
- Provider decision to submit results as an individual.
- State is listed in group 2 (see MU: State Group SQL Table and MU: State Assumptions).
- Depending on your billing, you may need to make some adjustments to the SQL code to exclude certain CPT codes from Encounter visits and/or to exclude some insurance payers as Medicaid.
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with t as ( select staffname, count(uniqid) as encounters, det from ( select distinct uniqid, staff1.staffname, a.ins_carrier_code, a.ins_carrier_code_other, i1.claim_filing_code as c1, i2.claim_filing_code as c2, case when (i1.claim_filing_code = 'MC' or i2.claim_filing_code = 'MC') then 'Medicaid' else 'not Medicaid' end as det from ( select patno, rend_addr_id, date1, (patno || ' ' || date1) as uniqid, cptcode, at1.ins_carrier_code, at1.ins_carrier_code_other from archive_transactions at1 where at1.cptcode not in ('1','2','3','4') and pos not in (21,23) and at1.cptcode not in ('113','99999','P1001') and at1.ins_carrier_code not in ('XCLUDE') and at1.date1 between :attestation_start and ( :attestation_start + 89) and at1.archive_flag = 1 ) a left outer join ins_carrier i1 on i1.ins_carrier_code = a.ins_carrier_code left outer join ins_carrier i2 on i2.ins_carrier_code = a.ins_carrier_code_other left outer join staff1 on staff1.staffid = a.rend_addr_id ) group by staffname, det order by staffname) select b.*, round(( ( ((med_enc-chip_enc) / total_enc))*100),1) as medicaid_pct_post_adjustment from ( select staffname, med_enc, non_med_enc, med_enc+non_med_enc as total_enc, medicaid_pct_pre_adjustment, adj_factor, round(adj_factor * med_enc,0) as CHIP_enc from ( select distinct staffname, med_enc, non_med_enc, cast(:adjustment_factor as float) as adj_factor, round(((med_enc / (non_med_enc + med_enc))*100),1) as medicaid_pct_pre_adjustment from t left outer join (select encounters as Med_enc, staffname from t where det = 'Medicaid') m on m.staffname = t.staffname left outer join (select encounters as non_med_enc, staffname from t where det = 'not Medicaid') n on n.staffname = t.staffname where staffname <> '' ) ) b