B QC Scoring Example

FAA6.N Examples : 37 Administrative Examples : B QC Scoring Example

Each area reviewed by AHCCCS ME is given a score. The error rate calculation is determined as follows:

Example 1:

Cases pulled	Correct	Error	Deficient	Undetermined
20	20	0	0	0

Score: 100%

Example 2:

Cases pulled	Correct	Error	Deficient	Undetermined
20	15	3	2	0

Score: 75%

Explanation:

15 corrects are divided by 20 equals 75% correct.

3 incorrects divided by 20 equals 15% incorrect.

2 deficiencies divided by 20 equals 10% deficient.

0 undetermined divided by 20 equals 0% undetermined.

The total percentage scored in each area is deducted from a possible 100% as follows:

●Incorrect score is 15%.

●Deficiency score is 0%. (Only the portion of a deficiency score that exceeds the 15% tolerance level would be included)

●Undetermined score 0%. (Only the portion of the undetermined score that exceeds the 5% tolerance level would be included)

To determine the weight to assign to each area reviewed, complete the following:

●Deduct the 15% from the 100% total that is available.

●Multiply 85 by 15% to calculate the weight for the approval category. The weight for the approval category is established at 12.75.

●The weighted score for each area reviewed is added together for the total score for the local office.

The standards agreed upon by AHCCCS and FAA in the IGA are as follows:

●95 ‑ 100% (Full compliance)

●80 ‑ 94% (Substantial compliance)

●Below 80% (Noncompliance)